Individual
ROLF P MOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
402 JAMES STREET, BRAINERD, MN 56401-2965
(218) 829-4243
(218) 825-8102
Mailing address
402 JAMES STREET, BRAINERD, MN 56401-2965
(218) 829-4243
(218) 825-8102
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9531
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05220700
—
MN
Enumeration date
12/19/2006
Last updated
07/08/2007
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