| Roger Mondale, Dds | |
|
10600 Old County Rd 15 Suite 120 Plymouth MN 55441-6205 | |
| (763) 512-8500 | |
| (763) 512-8592 |
| Full Name | Roger Mondale, Dds |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 10600 Old County Rd 15, Plymouth, Minnesota |
| Authorized Official Name and Position | Brian Patrick Mondale (OWNER SOLE MEMBER) |
| Authorized Official Contact | 7635128500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Roger Mondale, Dds 10600 Old County Rd 15 Suite 120 Plymouth MN 55441-6205 Ph: (763) 512-8500 | Roger Mondale, Dds 10600 Old County Rd 15 Suite 120 Plymouth MN 55441-6205 Ph: (763) 512-8500 |
| NPI Number | 1053834481 |
|---|---|
| Provider Enumeration Date | 07/18/2017 |
| Last Update Date | 07/30/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053834481 | NPI | - | NPPES |
| 744487700 | Medicaid | MN | |
| 744487700MN | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
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