MEDICARE: DR. ROBERT JOHN MAROLT D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	9611	MN

General Provider Information

NPI Number	:	1518045756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JOHN MAROLT D.D.S.

Provider Business Mailing Address
First Line	:	24 RAVEN RD
Second Line	:
City	:	NORTH OAKS
State	:	MN
Zip	:	55127-2046
Country	:	US
Telephone Number	:	651-486-9786
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 WILDWOOD RD
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55115-1847
Country	:	US
Telephone Number	:	651-770-2699
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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