Provider Demographics
NPI:1639153364
Name:PALMQUIST DENTAL PA
Entity Type:Organization
Organization Name:PALMQUIST DENTAL PA
Other - Org Name:ROGER K PALMQUIST DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:K
Authorized Official - Last Name:PALMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-388-4130
Mailing Address - Street 1:303 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2521
Mailing Address - Country:US
Mailing Address - Phone:651-388-4130
Mailing Address - Fax:651-385-7817
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:651-385-7817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND79591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty