Provider Demographics
NPI:1225229503
Name:ROGER E AUSTIN, DDS, PA
Entity Type:Organization
Organization Name:ROGER E AUSTIN, DDS, PA
Other - Org Name:RAMSEY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:E
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-421-2660
Mailing Address - Street 1:15243 NOWTHEN BLVD NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-6138
Mailing Address - Country:US
Mailing Address - Phone:763-421-2660
Mailing Address - Fax:763-421-2661
Practice Address - Street 1:15243 NOWTHEN BLVD NW
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-6138
Practice Address - Country:US
Practice Address - Phone:763-421-2660
Practice Address - Fax:763-421-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN070571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1184614117OtherNPI ENUMERATOR FOR ROGER