Provider Demographics
NPI:1942475330
Name:MINNESOTA STATE COLLEGES AND UNIVERSITIES - ROCHESTER COMMUNITY & TECH
Entity type:Organization
Organization Name:MINNESOTA STATE COLLEGES AND UNIVERSITIES - ROCHESTER COMMUNITY & TECH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF DENTAL HYGIENE
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HIGH
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, MS
Authorized Official - Phone:507-280-3114
Mailing Address - Street 1:851 30TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-4915
Mailing Address - Country:US
Mailing Address - Phone:507-280-3169
Mailing Address - Fax:507-280-3180
Practice Address - Street 1:851 30TH AVE SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4915
Practice Address - Country:US
Practice Address - Phone:507-280-3169
Practice Address - Fax:507-280-3180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-07-24
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-07-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental