Mondale, Roger Alan
Mondale, Roger Alan is an sole proprietor health care provider with primary practice located at 10600 Old County Rd. 15 Suite 120, Plymouth MN 55441. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Mondale, Roger Alan can be contacted via phone (763) 512-8500.Contact Information
Primary practice address
10600 Old County Rd. 15 Suite 120
Plymouth MN 55441
Phone: (763) 512-8500
Fax: (763) 512-8592
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | D7579 | Minnesota |
Profile Details
| NPI number | 1023170248 |
|---|---|
| LBN Legal business name | Mondale, Roger Alan |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 14th, 2006 |
| Last updated | Dec 16th, 2009 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1023170248 | NPPES |
| Minnesota | MEDICAID | 970215600 |
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