Provider Demographics
NPI:1316465677
Name:PREUSS, BRANDON PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:PAUL
Last Name:PREUSS
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 1:405 MANOR RIDGE DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3188
Mailing Address - Country:US
Mailing Address - Phone:763-242-1048
Mailing Address - Fax:
Practice Address - Street 1:600 E 17TH ST S STE A
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-4014
Practice Address - Country:US
Practice Address - Phone:641-792-4832
Practice Address - Fax:641-792-8843
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-10141122300000X, 1223G0001X
MND13808122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1053585653OtherDOUGLAS J MCNAUGHT D D S P A