Provider Demographics
NPI:1033677208
Name:CHRISTIE BERKSETH-ROJAS LLC
Entity Type:Organization
Organization Name:CHRISTIE BERKSETH-ROJAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BERKSETH-ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-315-6955
Mailing Address - Street 1:3533 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4528
Mailing Address - Country:US
Mailing Address - Phone:612-730-5658
Mailing Address - Fax:
Practice Address - Street 1:3455 4TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4527
Practice Address - Country:US
Practice Address - Phone:612-315-6955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1962795856Medicaid