Provider Demographics
NPI:1790743714
Name:RASMUSSEN, RONALD LEE
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEE
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-1652
Mailing Address - Country:US
Mailing Address - Phone:507-825-4214
Mailing Address - Fax:507-825-4216
Practice Address - Street 1:118 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-1652
Practice Address - Country:US
Practice Address - Phone:507-825-4214
Practice Address - Fax:507-825-4216
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN86581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8658OtherLICENSE #