Organization
MINNEAPOLIS-ST. PAUL PERIODONTICS
Active
Parent organization
ST. CROIX VALLEY DENTAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. CROIX VALLEY DENTAL
Authorized official
DR. DOUG S WOLFF D.D.S. (OWNER)
(651) 439-2600
Entity
Organization
Contact information
Practice address
1109 EAST MOORE LAKE DRIVE, FRIDLEY, MN 55432
(651) 439-2600
(651) 439-2211
Mailing address
1109 EAST MOORE LAKE DRIVE, FRIDLEY, MN 55432
(651) 439-2600
(651) 439-2211
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D11710
MN
Other
Enumeration date
03/18/2011
Last updated
03/18/2011
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