Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Minnesota Periodontal Associates, PA

Organization Periodontics · NPI 1508300252

Minnesota Periodontal Associates, PA is a Periodontics in White Bear Lake, Minnesota. Licensed in Minnesota. Registered with an NPI since 2016.

Licensed in
MN
In the registry since
2016
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4801 Hwy 61 N Ste 300
White Bear Lake, MN 55110-2753
Phone: (651) 429-2299
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Periodontics (primary) Taxonomy 1223P0300X · Licence D13190 (MN)

Record details

NPI number1508300252
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Connie Lee — Periodontist · (651) 429-2299
Other names Roger G. Ettel Dds And Associates, Pa
NPI enumeratedDecember 15, 2016
Last updated in NPPESDecember 22, 2016
Mailing address4801 Hwy 61 N., Suite 300, White Bear Lake, MN 55110

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