Organization
SOUTH RIVER DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLINT MATTHEW KROEKER DDS (PRESIDENT)
(651) 455-0505
Entity
Organization
Contact information
Practice address
1545 LIVINGSTON AVE STE 101, WEST ST PAUL, MN 55118-3422
(651) 455-0505
Mailing address
1545 LIVINGSTON AVE STE 101, WEST ST PAUL, MN 55118-3422
(651) 455-0505
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/02/2022
Last updated
05/02/2022
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