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Organization

ROGER G. ETTEL D.D.S. & ASSOCIATES, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ROGER G ETTEL D.D.S.,M.S. (OWNER)
(651) 429-2299
Entity
Organization

Contact information

Practice address
4801 HIGHWAY 61 N # SU-300, WHITE BEAR LAKE, MN 55110-2737
(651) 429-2299
(651) 429-6630
Mailing address
4801 HIGHWAY 61 N # SU-300, WHITE BEAR LAKE, MN 55110-2737
(651) 429-2299
(651) 429-6630

Taxonomy

Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
1223PO300X
MN

Other

Enumeration date
12/14/2006
Last updated
07/30/2008
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