# BIG LAKE DENTAL, PA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Sand Prairie Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518141548
- **Authorized official:** DR. ROGER J BROMAGHIM D.D.S. (OWNER)
- **Authorized official phone:** (763) 263-6350

## Contact information

- **Practice address:** 16991 198TH AVENUE NW, BIG LAKE, MN 55309-0249
- **Practice address phone:** (763) 263-6350
- **Practice address fax:** (763) 263-0136
- **Mailing address:** PO BOX 249, BIG LAKE, MN 55309-0249
- **Mailing address phone:** (763) 263-6350
- **Mailing address fax:** (763) 263-0136

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D9355 | MN | Yes |

## Other

- **Enumeration date:** 12/27/2007
- **Last updated:** 12/27/2007