Healthcare Provider Details

I. General information

NPI: 1588460042
Provider Name (Legal Business Name): AUGUSTA ACQUAAH DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 N. BROADWAY AVE STE 104
ROCHESTER MN
55906
US

IV. Provider business mailing address

2460 N. BROADWAY AVE STE 104
ROCHESTER MN
55906
US

V. Phone/Fax

Practice location:
  • Phone: 507-282-6447
  • Fax:
Mailing address:
  • Phone: 507-282-6447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. AUGUSTA ACQUAAH
Title or Position: ORTHODONTIST
Credential:
Phone: 507-282-6447