| Roger G. Ettel Dds And Associates, Pa | |
|
4801 Hwy 61 N. Suite 300 White Bear Lake MN 55110-2753 | |
| (651) 429-2299 | |
| Not Available |
| Full Name | Roger G. Ettel Dds And Associates, Pa |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 4801 Hwy 61 N., White Bear Lake, Minnesota |
| Authorized Official Name and Position | Connie A Lee (PERIODONTIST) |
| Authorized Official Contact | 6514292299 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Roger G. Ettel Dds And Associates, Pa 4801 Hwy 61 N. Suite 300 White Bear Lake MN 55110 Ph: (651) 429-2299 | Roger G. Ettel Dds And Associates, Pa 4801 Hwy 61 N. Suite 300 White Bear Lake MN 55110-2753 Ph: (651) 429-2299 |
| NPI Number | 1508300252 |
|---|---|
| Provider Enumeration Date | 12/15/2016 |
| Last Update Date | 12/22/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508300252 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | D13190 (Minnesota) | Primary |
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