| South River Dental Pllc | |
|
1545 Livingston Ave Ste 101 West St Paul MN 55118-3422 | |
| (651) 455-0505 | |
| Not Available |
| Full Name | South River Dental Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1545 Livingston Ave Ste 101, West St Paul, Minnesota |
| Authorized Official Name and Position | Clint Matthew Kroeker (PRESIDENT) |
| Authorized Official Contact | 6514550505 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South River Dental Pllc 1545 Livingston Ave Ste 101 West St Paul MN 55118-3422 Ph: (651) 455-0505 | South River Dental Pllc 1545 Livingston Ave Ste 101 West St Paul MN 55118-3422 Ph: (651) 455-0505 |
| NPI Number | 1154066405 |
|---|---|
| Provider Enumeration Date | 05/02/2022 |
| Last Update Date | 05/02/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154066405 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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