MONDALE DENTAL LLC NPI 1053834481

NPI Information

NPI: 1053834481
Provider Name: MONDALE DENTAL LLC
Classification: Dentist - 1223G0001X
Specialization: General Practice
Entity Type: Organization
Doing Business As: ROGER MONDALE, DDS
Address: 10600 OLD COUNTY RD 15
SUITE 120
PLYMOUTH, MN
ZIP 55441
Phone: (763) 512-8500

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NPI Details

MONDALE DENTAL LLC is a general practice dentist in Plymouth, MN. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. MONDALE DENTAL LLC NPI is 1053834481. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Roger Mondale, Dds.

The provider's business location address is:

10600 OLD COUNTY RD 15
SUITE 120
PLYMOUTH, MN
ZIP 55441-205
Phone: (763) 512-8500
Fax: (763) 512-8592

The provider's authorized official is Brian Patrick Mondale .
The authorized official title is Owner Sole Member and has the following contact phone number (763) 512-8500.

The enumeration date for this NPI number is 7/18/2017 and was last updated on 7/30/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223G0001X	Dentist	General Practice			Yes
2	261QD0000X	Clinic/Center	Dental			No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	744487700	MEDICAID	MINNESOTA
2	744487700MN	MEDICAID	MINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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