Organization
ST. CROIX ENDODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SERENA JEAN PEDERSEN (OFFICE MANAGER)
(763) 767-9119
Entity
Organization
Contact information
Practice address
25 LAKE ST N, SUITE 110, FOREST LAKE, MN 55025-2535
(651) 464-7388
(651) 982-6236
Mailing address
25 LAKE ST N, SUITE 110, FOREST LAKE, MN 55025-2535
(651) 464-7388
(651) 982-6236
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Enumeration date
12/15/2014
Last updated
11/23/2020
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