Healthcare Provider Details

I. General information

NPI: 1104906379
Provider Name (Legal Business Name): MICHAEL J ROSCHER DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 HASTINGS AVE
NEWPORT MN
55055-1646
US

IV. Provider business mailing address

1590 HASTINGS AVE
NEWPORT MN
55055-1646
US

V. Phone/Fax

Practice location:
  • Phone: 651-459-2387
  • Fax: 651-459-3259
Mailing address:
  • Phone: 651-459-2387
  • Fax: 651-459-3259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberMN8121
License Number StateMN

VIII. Authorized Official

Name: DR. MICHAEL JAY ROSCHER
Title or Position: OWNER
Credential: DDS
Phone: 651-459-2387