Provider Demographics
NPI:1619496700
Name:ROGERS MINNESOTA ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:ROGERS MINNESOTA ORTHODONTICS PLLC
Other - Org Name:ROGERS MINNESOTA ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:LDA
Authorized Official - Phone:651-450-7273
Mailing Address - Street 1:13690 ROGERS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4899
Mailing Address - Country:US
Mailing Address - Phone:651-450-7273
Mailing Address - Fax:
Practice Address - Street 1:13690 ROGERS DR STE 100
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4899
Practice Address - Country:US
Practice Address - Phone:651-450-7273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINNESOTA ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND130031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty