Healthcare Provider Details

I. General information

NPI: 1932046596
Provider Name (Legal Business Name): PINE ISLAND DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 S MAIN ST
PINE ISLAND MN
55963-9190
US

IV. Provider business mailing address

4607 ROYAL DR
EAU CLAIRE WI
54701-2928
US

V. Phone/Fax

Practice location:
  • Phone: 715-833-8755
  • Fax:
Mailing address:
  • Phone: 715-833-8755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: STEVE ROHRSCHEIB
Title or Position: ACCOUNTANT
Credential:
Phone: 715-833-8755