Provider Demographics
NPI:1942739818
Name:ROGNESS, NICHOLAS (DDS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:ROGNESS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N47502 HOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:STRUM
Mailing Address - State:WI
Mailing Address - Zip Code:54770-8703
Mailing Address - Country:US
Mailing Address - Phone:715-797-1313
Mailing Address - Fax:
Practice Address - Street 1:100 E COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:SLINGER
Practice Address - State:WI
Practice Address - Zip Code:53086-9748
Practice Address - Country:US
Practice Address - Phone:262-644-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001559-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist