Provider Demographics
NPI:1780931857
Name:RONALD L. RASMUSSEN, DDS, INC
Entity type:Organization
Organization Name:RONALD L. RASMUSSEN, DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-825-4214
Mailing Address - Street 1:118 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-1652
Mailing Address - Country:US
Mailing Address - Phone:507-825-4214
Mailing Address - Fax:507-825-4216
Practice Address - Street 1:118 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-1652
Practice Address - Country:US
Practice Address - Phone:888-825-4214
Practice Address - Fax:507-825-4216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13035122300000X
IA13036122300000X
MN8658122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty