Paul Anthony Roggow, D.D.S.
Individual provider Active NPI Dentist · Jackson, MN
NPI 1285978221 · NPPES record last updated Nov 15, 2012
Key facts
- NPI
- 1285978221
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 9644 (MN)
- Practice address
- 604 Second Street
Jackson, MN 56143 - Phone
- (507) 847-3910
- Fax
- (507) 847-2868
- NPI assigned
- Nov 15, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9644 | MN | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9644 | MN | Yes |
Addresses
Primary practice location
604 Second Street
Jackson, MN 56143
Mailing address
604 Second Street
Jackson, MN 56143
Phone (507) 847-3910
Other providers in Jackson, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.