Individual
DR. ROGER JOSEPH BROMAGHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
16991 198TH AVENUE NW, BIG LAKE, MN 55309-0249
(763) 263-6350
(763) 263-0136
Mailing address
16991 198TH AVENUE NW, 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
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D9355
STATE LICENSE
MN
Enumeration date
03/07/2007
Last updated
07/09/2007
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