ROGER G. ETTEL D.D.S. & ASSOCIATES PA NPI 1194887521

NPI Information

  • NPI: 1194887521
  • Provider Name: ROGER G. ETTEL D.D.S. & ASSOCIATES, PA
  • Classification: Dentist - 1223P0300X
  • Specialization: Periodontics
  • Entity Type: Organization
  • Address: 4801 HIGHWAY 61 N # SU-300
    WHITE BEAR LAKE, MN
    ZIP 55110
  • Phone: (651) 429-2299

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NPI Details

ROGER G. ETTEL D.D.S. & ASSOCIATES, PA is a periodontics dentist in White Bear Lake, MN. The provider is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. ROGER G. ETTEL D.D.S. & ASSOCIATES, PA NPI is 1194887521. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4801 HIGHWAY 61 N # SU-300
WHITE BEAR LAKE, MN
ZIP 55110-737
Phone: (651) 429-2299
Fax: (651) 429-6630

The provider's authorized official is Roger G Ettel .
The authorized official title is Owner and has the following contact phone number (651) 429-2299.

The enumeration date for this NPI number is 12/14/2006 and was last updated on 7/30/2008.

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
11223P0300XDentistPeriodontics1223PO300XMINNESOTAYes

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: 11/21/2025

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