South River Dental Pllc

LBN: South River Dental Pllc
South River Dental Pllc is an health care organization with primary practice located at 1545 Livingston Ave Ste 101 , West St Paul MN 55118-3422. The organization recently has only one registered license in Ambulatory Health Care Facilities / Dental, which is considered as the primary health care specialty. South River Dental Pllc can be contacted via phone (651) 455-0505, or through Kroeker, Clint Matthew via phone (651) 455-0505.

Contact Information

Primary practice address
1545 Livingston Ave Ste 101 West St Paul MN 55118-3422
Phone: (651) 455-0505
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Kroeker, Clint Matthew Doctor of Dental Surgery (DDS)
Phone: (651) 455-0505

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Dental 261QD0000X

Profile Details

NPI number 1154066405
LBN Legal business name South River Dental Pllc
DBA Doing business as
Authorized official Kroeker, Clint Matthew Doctor of Dental Surgery (DDS)
Entity Organization
Organization subpart 1 No
Enumeration date May 2nd, 2022
Last updated May 2nd, 2022 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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