Healthcare Provider Details

I. General information

NPI: 1417890245
Provider Name (Legal Business Name): SOUTHRIDGE FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MENDOTA RD
INVER GROVE HEIGHTS MN
55077-1255
US

IV. Provider business mailing address

659 CRESTVIEW LN
OWATONNA MN
55060-2109
US

V. Phone/Fax

Practice location:
  • Phone: 651-451-1884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MATTHEW JOHN WORKE
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 507-438-8990