Roger Alan Mondale, D.D S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D7579 Issued in MN

Practice address

10600 Old County Rd. 15
Suite 120
Plymouth, MN 55441

Phone

(763) 512-8500

Fax

(763) 512-8592

NPI assigned

Dec 14, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mondale Dental LLC

  • General Practice Dentistry
  • Plymouth, MN
  • NPI 1053834481
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260921600000",
    "number": "1023170248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10600 OLD COUNTY RD 15",
            "address_2": "SUITE 120",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "55441",
            "telephone_number": "763-512-8500",
            "fax_number": "763-512-8592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10600 OLD COUNTY RD. 15",
            "address_2": "SUITE 120",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "55441",
            "telephone_number": "763-512-8500",
            "fax_number": "763-512-8592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONDALE",
        "first_name": "ROGER",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.D S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2009-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D7579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "970215600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeanne Mohler, M.D.
• Matthew Moldan, M.D.
• Katheryn Monahan
• Monarch Behavioral Health PLLC
• Mondale Dental LLC
• Benjamin Monseth
• Amanda Beth Monson, DNP, APRN, CRNA
• Sandra Rocio Montezuma, M.D.
• Paul Daeboo Moon, D.C.
• Derryck Vancurk Moore, LADC

• General Practice Dentistry in Plymouth, MN
• Providers in Plymouth, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.