Provider Demographics
NPI:1013646827
Name:ROGGE, MITCHELL JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:JAMES
Last Name:ROGGE
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 1:3048 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3425
Mailing Address - Country:US
Mailing Address - Phone:952-334-4062
Mailing Address - Fax:
Practice Address - Street 1:8977 HUNTERS WAY
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-9486
Practice Address - Country:US
Practice Address - Phone:952-900-6086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND147431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice