Provider Demographics
NPI:1184869778
Name:DIGNIFIED DENTAL
Entity type:Organization
Organization Name:DIGNIFIED DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSALIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERPICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:651-351-0890
Mailing Address - Street 1:1725 TOWER DR W
Mailing Address - Street 2:SUITE #130
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-7585
Mailing Address - Country:US
Mailing Address - Phone:651-351-0890
Mailing Address - Fax:651-351-1922
Practice Address - Street 1:5600 NORWICH PKWY
Practice Address - Street 2:
Practice Address - City:OAK PARK HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55082-6482
Practice Address - Country:US
Practice Address - Phone:651-366-0923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11196313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility