Provider Demographics
NPI:1497712442
Name:PALMQUIST, ROGER KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:KENNETH
Last Name:PALMQUIST
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 1:529 9TH ST
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-3158
Mailing Address - Country:US
Mailing Address - Phone:651-388-4484
Mailing Address - Fax:
Practice Address - Street 1:303 W 5TH ST
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2521
Practice Address - Country:US
Practice Address - Phone:651-388-4130
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7959122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist