OrganizationActive
Minnesota Periodontal Associates, PA
NPI 1508300252 · Periodontics · White Bear Lake, MN
Minnesota Periodontal Associates, PA is a Periodontics organization in White Bear Lake, MN (NPI 1508300252).
Provider details
- NPI number
- 1508300252
- Entity type
- Organization
- Primary specialty
- PeriodonticsDental Providers
- Organization subpart
- No
- Authorized official
- Connie Lee, Periodontist(651) 429-2299
- License
- D13190 (MN)
Specialties & taxonomies
Dental Providers
Profile Score
Established profile(71/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4801 Hwy 61 N.
Suite 300
White Bear Lake, MN 55110-2753
Phone: (651) 429-2299
Street-level locationGet directions
Mailing address
4801 Hwy 61 N.
White Bear Lake, MN 55110
Other names (DBA / former)
- Doing business as
- Roger G. Ettel DDS and Associates, PA
Registry dates
- Enumerated
- 2016-12-15
- Last updated
- 2016-12-22
Frequently asked questions
- What is Minnesota Periodontal Associates, PA's NPI number?
- Minnesota Periodontal Associates, PA's National Provider Identifier (NPI) is 1508300252, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Minnesota Periodontal Associates, PA?
- Minnesota Periodontal Associates, PA is classified in the NPPES registry as Periodontics (Dental Providers).
- Where is Minnesota Periodontal Associates, PA located?
- Minnesota Periodontal Associates, PA's practice location on file with NPPES is 4801 Hwy 61 N., White Bear Lake, MN 55110-2753.
- What is Minnesota Periodontal Associates, PA's phone number?
- The practice phone number listed in the NPPES registry for Minnesota Periodontal Associates, PA is (651) 429-2299.
- Who is the authorized official for Minnesota Periodontal Associates, PA?
- The authorized official listed on Minnesota Periodontal Associates, PA's NPPES record is Connie Lee, Periodontist. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Minnesota Periodontal Associates, PA's NPI active?
- Yes — Minnesota Periodontal Associates, PA's NPI (1508300252) is active in the NPPES registry as of the last update on 2016-12-22.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.