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General NPI Number Information
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NPI Number | 1689842841
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Entity Type | Organization
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Legal Business Name | ST. CROIX VALLEY DENTAL, PLLC
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 13961 60TH ST N
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City | STILLWATER
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State | MN
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Zip | 55082-1053
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Country | US
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Telephone | 651-351-7777
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Fax | 651-351-5161
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Provider Business Mailing Address
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Address Line | 13961 60TH ST N PO BOX 270
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City | STILLWATER
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State | MN
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Zip | 55082-1053
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Country | US
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Telephone | 651-351-7777
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Fax | 651-351-5161
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOUGLAS S WOLFF
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Credential | D.D.S
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Telephone | 651-351-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D10622
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License Number State | MN
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