Organization
MONDALE DENTAL LLC
Active
Other names
Roger Mondale, DDS, Roger Mondale DDS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN PATRICK MONDALE D.D.S. (OWNER SOLE MEMBER)
(763) 512-8500
Entity
Organization
Contact information
Practice address
10600 OLD COUNTY RD 15, SUITE 120, PLYMOUTH, MN 55441-6205
(763) 512-8500
(763) 512-8592
Mailing address
10600 OLD COUNTY RD 15, SUITE 120, PLYMOUTH, MN 55441-6205
(763) 512-8500
(763) 512-8592
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
744487700
—
MN
05
—
744487700MN
—
MN
Enumeration date
07/18/2017
Last updated
07/30/2024
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