NPI 1154066405

South River Dental PLLC

Organisation Dental Clinic/Center West St Paul, MN

Practice location

Address: 1545 Livingston Ave STE 101, West St Paul, MN 55118-3422
Phone: (651) 455-0505

Authorised official

Name: Clint Matthew Kroeker
Title: President
Phone: (651) 455-0505

Registered specialties

Dental Clinic/Center Primary

Ambulatory Health Care Facilities Taxonomy 261QD0000X

Other Clinic/Center providers in Minnesota →

Registry record

NPI: 1154066405
Entity type: Organization
NPI issued: 2 May 2022
Record last updated: 2 May 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.