Organization
MINNESOTA PERIODONTAL ASSOCIATES, PA
Active
Other names
Roger G. Ettel DDS and Associates, PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CONNIE A LEE D.D.S., M.S. (PERIODONTIST)
(651) 429-2299
Entity
Organization
Contact information
Practice address
4801 HWY 61 N., SUITE 300, WHITE BEAR LAKE, MN 55110-2753
(651) 429-2299
Mailing address
4801 HWY 61 N., SUITE 300, WHITE BEAR LAKE, MN 55110
(651) 429-2299
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D13190
MN
Other
Enumeration date
12/15/2016
Last updated
12/22/2016
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