Mark T Roszkowski, DDS

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

D10761 Issued in MN

Practice address

625 E Nicollet Blvd
Ste 205
Burnsville, MN 55337-6734

Phone

(952) 435-0310

Fax

(952) 435-0311

NPI assigned

Dec 9, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Mar 20, 2015 through Mar 20, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Great Lakes Oral & Maxillofacial Surgery, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Stillwater, MN
  • NPI 1508058322
  NPD (past)

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

{
    "created_epoch": "1134086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278633600000",
    "number": "1699750802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 E NICOLLET BLVD",
            "address_2": "STE 205",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553376734",
            "telephone_number": "952-435-0310",
            "fax_number": "952-435-0311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 E NICOLLET BLVD",
            "address_2": "STE 205",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553376734",
            "telephone_number": "952-435-0310",
            "fax_number": "952-435-0311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSZKOWSKI",
        "first_name": "MARK",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-09",
        "last_updated": "2010-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MN",
            "license": "D10761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "317R7RO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "227315200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lucia Rosales
• Brady David Rose, DC
• Callie Rose, LICSW
• Ozzy Rose
• Pat M Ross, CERTIFIED ORTHOTIST
• Mark Bryan Rother, BC-HIS
• Loveth Rowland
• Avery Marie Roy, DC
• Royal Crown Homes
• Royal Crown Homes

• Oral & Maxillofacial Surgery (D.M.D.) in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2010; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.