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General NPI Number Information
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NPI Number | 1528182342
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Entity Type | Organization
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Legal Business Name | MAINSTREET DENTAL
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 29 - 9TH AVENUE NORTH
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City | HOPKINS
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State | MN
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Zip | 55343-8087
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Country | US
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Telephone | 952-938-7341
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Fax | 952-938-9361
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Provider Business Mailing Address
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Address Line | 29 - 9TH AVENUE NORTH
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City | HOPKINS
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State | MN
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Zip | 55343-8087
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Country | US
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Telephone | 952-938-7341
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Fax | 952-938-9361
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. WILLIAM PITT ROLFE JR.
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Credential | DDS
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Telephone | 952-938-7341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8343
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License Number State | MN
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