Provider Demographics
NPI:1104906379
Name:MICHAEL J ROSCHER DDS, PA
Entity type:Organization
Organization Name:MICHAEL J ROSCHER DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:ROSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-459-2387
Mailing Address - Street 1:1590 HASTINGS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:MN
Mailing Address - Zip Code:55055-1646
Mailing Address - Country:US
Mailing Address - Phone:651-459-2387
Mailing Address - Fax:651-459-3259
Practice Address - Street 1:1590 HASTINGS AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:MN
Practice Address - Zip Code:55055-1646
Practice Address - Country:US
Practice Address - Phone:651-459-2387
Practice Address - Fax:651-459-3259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN8121261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental