South River Dental Pllc
NPI #1154066405 in West St Paul, Minnesota
Provider Information
- NPI Number
- 1154066405
- Entity Type
- Organization
- Organization Name
- South River Dental Pllc
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- May 2, 2022
- Last Updated
- May 2, 2022
Practice Location
- Address
- 1545 LIVINGSTON AVE STE 101
- City
- West St Paul
- State
- Minnesota
- ZIP Code
- 55118-3422
- Phone
- (651) 455-0505
Authorized Official
- Name
- CLINT MATTHEW KROEKER, DDS
- Title
- PRESIDENT
- Phone
- (651) 455-0505
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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