Round Lake Dental P.a.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D10339 Issued in MN

Legal business name

ROUND LAKE DENTAL P.A.

Practice address

13841 Round Lake Blvd NW
Andover, MN 55304-3664

Phone

(763) 427-0285

Fax

(763) 576-0156

NPI assigned

Mar 14, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Thomas Richard Swenson, DDS

Title

President

Phone

(763) 427-0285

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376676445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13841 ROUND LAKE BLVD NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043664",
            "telephone_number": "763-427-0285",
            "fax_number": "763-576-0156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13841 ROUND LAKE BLVD NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043664",
            "telephone_number": "763-427-0285",
            "fax_number": "763-576-0156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROUND LAKE DENTAL P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SWENSON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-427-0285",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MN",
            "license": "D10339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen William Robinson, M.D.
• Pamela Ann Robsahm, MT
• Scot Rochon
• Cynthia Roeller, M.A., LMFT
• Christina Mary Rothstein
• Round Lake Family Dentistry, PLLC
• Julie Ann Rowland, MA, CCC-SLP
• Rtkramer LLC
• Sarah Rudesill, M.A. CCC-SLP
• Charles Ruegemer, PA-C

• All providers in Andover, MN
• Pediatric Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.