Provider Demographics
NPI:1811725997
Name:ROSEMOUNT MINNESOTA ORTHODONTICS
Entity type:Organization
Organization Name:ROSEMOUNT MINNESOTA ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDNIATOR
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-450-7273
Mailing Address - Street 1:2019 JEFFERSON RD STE C
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-3258
Mailing Address - Country:US
Mailing Address - Phone:651-450-7273
Mailing Address - Fax:
Practice Address - Street 1:14455 S ROBERT TRL
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-4932
Practice Address - Country:US
Practice Address - Phone:651-450-7273
Practice Address - Fax:507-645-1684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental