Organization
BIG LAKE DENTAL, PA
Active
Other names
Sand Prairie Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER J BROMAGHIM D.D.S. (OWNER)
(763) 263-6350
Entity
Organization
Contact information
Practice address
16991 198TH AVENUE NW, BIG LAKE, MN 55309-0249
(763) 263-6350
(763) 263-0136
Mailing address
PO BOX 249, BIG LAKE, MN 55309-0249
(763) 263-6350
(763) 263-0136
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D9355
MN
Other
Enumeration date
12/27/2007
Last updated
12/27/2007
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