Provider Demographics
NPI:1265512420
Name:ROWLETTE, MICHAEL TODD (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
Last Name:ROWLETTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:TODD
Other - Last Name:ROWLETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:NETT LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55772-0021
Mailing Address - Country:US
Mailing Address - Phone:218-753-4221
Mailing Address - Fax:
Practice Address - Street 1:13071 NETT LAKE RD
Practice Address - Street 2:
Practice Address - City:ORR
Practice Address - State:MN
Practice Address - Zip Code:55771-8111
Practice Address - Country:US
Practice Address - Phone:218-757-3241
Practice Address - Fax:218-757-0234
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND9668M122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist