Provider Demographics
NPI:1295809770
Name:ROSTAD, ROBERT A (DDS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:ROSTAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:ALLAN
Other - Last Name:ROSTAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS PA
Mailing Address - Street 1:102 FRONT ST SE PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56514-0520
Mailing Address - Country:US
Mailing Address - Phone:218-354-2289
Mailing Address - Fax:218-354-2899
Practice Address - Street 1:102 FRONT ST SE
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56514-0520
Practice Address - Country:US
Practice Address - Phone:218-354-2289
Practice Address - Fax:218-354-2899
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND8753122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist