Provider Demographics
NPI:1528182342
Name:MAINSTREET DENTAL
Entity Type:Organization
Organization Name:MAINSTREET DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PITT
Authorized Official - Last Name:ROLFE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-938-7341
Mailing Address - Street 1:29 - 9TH AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8087
Mailing Address - Country:US
Mailing Address - Phone:952-938-7341
Mailing Address - Fax:952-938-9361
Practice Address - Street 1:29 - 9TH AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8087
Practice Address - Country:US
Practice Address - Phone:952-938-7341
Practice Address - Fax:952-938-9361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8343122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty