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General NPI Number Information
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NPI Number | 1790389005
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Entity Type | Organization
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Legal Business Name | ST. CROIX ENDODONTICS
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Dates
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Enumeration Date | 11/27/2020
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 11855 ULYSSES ST NE STE 260
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City | BLAINE
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State | MN
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Zip | 55434-4182
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Country | US
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Telephone | 763-767-9119
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Fax |
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Provider Business Mailing Address
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Address Line | 11855 ULYSSES ST NE STE 260
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City | BLAINE
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State | MN
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Zip | 55434-4182
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Country | US
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Telephone | 763-767-9119
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Fax |
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Authorized Official
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Title or Position | BUSSINESS OFFICE MANAGER
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Name | KATIE KLEIN
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Credential |
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Telephone | 763-767-9119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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