Provider Demographics
NPI:1699817437
Name:PAUL A ROGGOW DDS PC
Entity Type:Organization
Organization Name:PAUL A ROGGOW DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ROGGOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-847-3910
Mailing Address - Street 1:604 SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-1646
Mailing Address - Country:US
Mailing Address - Phone:507-847-3910
Mailing Address - Fax:507-847-2868
Practice Address - Street 1:604 SECOND STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-1646
Practice Address - Country:US
Practice Address - Phone:507-847-3910
Practice Address - Fax:507-847-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9644122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty