Provider Demographics
NPI:1679705404
Name:ROY KRENGEL DDS PA
Entity type:Organization
Organization Name:ROY KRENGEL DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-888-1311
Mailing Address - Street 1:8900 PENN AVE S
Mailing Address - Street 2:SUITE #112
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2068
Mailing Address - Country:US
Mailing Address - Phone:952-888-1311
Mailing Address - Fax:952-888-3325
Practice Address - Street 1:8900 PENN AVE S
Practice Address - Street 2:SUITE #112
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-2068
Practice Address - Country:US
Practice Address - Phone:952-888-1311
Practice Address - Fax:952-888-3325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty