Organization
ST. CROIX VALLEY DENTAL, PLLC
Active
Other names
Rosemount Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS S. WOLFF D.D.S. (OWNER)
(651) 439-2600
Entity
Organization
Contact information
Practice address
14895 S ROBERT TRL, ROSEMOUNT, MN 55068-3108
(952) 423-2288
(952) 423-2203
Mailing address
14895 S ROBERT TRL, ROSEMOUNT, MN 55068-3108
(952) 423-2288
(952) 423-2203
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
D11236
MN
305S00000X
Point of Service
D11480
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071695000
MHCP
WI
01
—
275435000
MHCP
MN
01
—
38396800
MHCP
WI
01
—
617665000
MINNESOTA HEALTH CARE PROVIDER
MN
01
—
897945000
MHCP
MN
Enumeration date
05/09/2008
Last updated
05/09/2008
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