| St Croix Valley Dental Pllc | |
|
11240 Stillwater Blvd N Lake Elmo MN 55128 | |
| (651) 777-0210 | |
| (651) 777-0320 |
| Full Name | St Croix Valley Dental Pllc |
|---|---|
| Speciality | Dentist |
| Location | 11240 Stillwater Blvd N, Lake Elmo, Minnesota |
| Authorized Official Name and Position | Douglas Steven Wolff (OWNER DENTIST) |
| Authorized Official Contact | 6517770210 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St Croix Valley Dental Pllc 11240 Stillwater Blvd N Lake Elmo MN 55042 Ph: (651) 777-0210 | St Croix Valley Dental Pllc 11240 Stillwater Blvd N Lake Elmo MN 55128 Ph: (651) 777-0210 |
| NPI Number | 1891885000 |
|---|---|
| Provider Enumeration Date | 10/16/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891885000 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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