Provider Demographics
NPI:1063108801
Name:BEDINGHAM, JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:BEDINGHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:986 BRIAR GLEN LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-8574
Mailing Address - Country:US
Mailing Address - Phone:651-592-1493
Mailing Address - Fax:
Practice Address - Street 1:209 AQUADALE RD
Practice Address - Street 2:
Practice Address - City:OAKBORO
Practice Address - State:NC
Practice Address - Zip Code:28129-9045
Practice Address - Country:US
Practice Address - Phone:704-485-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC137911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice