Provider Demographics
NPI:1124556253
Name:ROGNESS, MALEA MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:MALEA
Middle Name:MARIE
Last Name:ROGNESS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MALEA
Other - Middle Name:MARIE
Other - Last Name:BLISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:N84W15959 APPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-3044
Mailing Address - Country:US
Mailing Address - Phone:262-251-6555
Mailing Address - Fax:
Practice Address - Street 1:N84W15959 APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3044
Practice Address - Country:US
Practice Address - Phone:262-251-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001543-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist