Provider Demographics
NPI:1851471460
Name:ROSEMOUNT FAMILY DENTISTRY PA
Entity Type:Organization
Organization Name:ROSEMOUNT FAMILY DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BERGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-423-3993
Mailing Address - Street 1:14590 SOUTH ROBERT TRAIL
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-3195
Mailing Address - Country:US
Mailing Address - Phone:651-423-3993
Mailing Address - Fax:651-423-1417
Practice Address - Street 1:14590 SOUTH ROBERT TRAIL
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-3195
Practice Address - Country:US
Practice Address - Phone:651-423-3993
Practice Address - Fax:651-423-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty