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ROGER G. ETTEL DDS AND ASSOCIATES, PA
NPI 1508300252
Dentist - Periodontics in White Bear Lake, MN

Active since December 15, 2016
4801 HWY 61 N., SUITE 300, WHITE BEAR LAKE, MN 55110(651) 429-2299 Get Directions Write a Review

NPPES record last updated: December 22, 2016. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Dec 22, 2016, Dec 15, 2016 (2 updates tracked since 2016).

About Roger G. Ettel Dds And Associates, Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ROGER G. ETTEL DDS AND ASSOCIATES, PA (NPI 1508300252) is a healthcare organization registered as a periodontics in White Bear Lake, Minnesota and active in the NPI registry since December 2016. The organization lists Connie A Lee, Periodontist, as its authorized official.

NPPES Registry Identity

NPI1508300252
Entity TypeOrganization
Primary Taxonomy1223P0300X
Legal Business NameMINNESOTA PERIODONTAL ASSOCIATES, PA
Location Address4801 HWY 61 N., SUITE 300White Bear Lake, MN 55110-2753
Mailing Address4801 Hwy 61 N., Suite 300White Bear Lake, MN 55110 · (651) 429-2299
Phone(651) 429-2299
Organization SubpartNo
Authorized OfficialConnie A LeePeriodontist · (651) 429-2299
Enumeration DateDecember 15, 2016
Last NPPES UpdateDecember 22, 20162 updates tracked since enumeration
✔ NPI 1508300252 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers
Taxonomy Code1223P0300X
License✔ Licensed in MN · D13190
Definition
That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
4801 HWY 61 N., White Bear Lake, MN 55110
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Other Names 1

Doing Business AsRoger G. Ettel Dds And Associates, Pa

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Minnesota Periodontal Associates, PA's NPI number?

The NPI number for Minnesota Periodontal Associates, PA is 1508300252. It was assigned to this organization in the NPPES registry on December 15, 2016. The provider is doing business as Roger G. Ettel Dds And Associates, PA.

Where is Minnesota Periodontal Associates, PA located?

Minnesota Periodontal Associates, PA is located at 4801 Hwy 61 N. Suite 300, White Bear Lake, MN 55110. The listed phone number is (651) 429-2299.

What is Minnesota Periodontal Associates, PA's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

When was this NPI record last updated?

The NPPES record for Minnesota Periodontal Associates, PA was last updated on December 22, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.