# THE DENTAL SPECIALIST OF MINNESOTA, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Dental Specialist St Croix Valley
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265097653
- **Authorized official:** SHANNON HESSE (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (651) 746-2815

## Contact information

- **Practice address:** 13961 60TH ST N, STILLWATER, MN 55082-1053
- **Practice address phone:** (651) 760-3681
- **Practice address fax:** (651) 760-3683
- **Mailing address:** 2200 COUNTY ROAD C W STE 2210, ROSEVILLE, MN 55113-2551

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 05/01/2019
- **Last updated:** 10/28/2020