Individual
DR. ROGER ALAN MONDALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D S.
Contact information
Practice address
10600 OLD COUNTY RD. 15, SUITE 120, PLYMOUTH, MN 55441
(763) 512-8500
(763) 512-8592
Mailing address
10600 OLD COUNTY RD 15, SUITE 120, PLYMOUTH, MN 55441
(763) 512-8500
(763) 512-8592
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7579
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
970215600
—
MN
Enumeration date
12/14/2006
Last updated
12/16/2009
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