Organization
ST. CROIX VALLEY DENTAL, PLLC
Active
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
Update your record
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