NPIMap

Organization Active NPI

St. Croix Valley Dental

  • Dentist
  • Hugo, MN
National Provider Identifier
1184878431
Registry record updated Nov 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D11236 Issued in MN
Legal business name
ST. CROIX VALLEY DENTAL
Practice address
14643 Mercantile Dr N
Suite 113
Hugo, MN 55038-4552
Phone
(651) 407-0999
NPI assigned
Nov 13, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kelly J Lemire
Title
Manager
Phone
(651) 439-2600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D11236 MN Primary

Addresses

Primary practice location

14643 Mercantile Dr N
Suite 113
Hugo, MN 55038-4552

Mailing address

14643 Mercantile Dr N
Suite 113
Hugo, MN 55038-4552
Phone (651) 407-0999

Other names 1

  • Oneka Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Minneapolis-St Paul Periodontics12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226534400000",
    "number": "1184878431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14643 MERCANTILE DR N",
            "address_2": "SUITE 113",
            "city": "HUGO",
            "state": "MN",
            "postal_code": "550384552",
            "telephone_number": "651-407-0999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14643 MERCANTILE DR N",
            "address_2": "SUITE 113",
            "city": "HUGO",
            "state": "MN",
            "postal_code": "550384552",
            "telephone_number": "651-407-0999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CROIX VALLEY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-13",
        "last_updated": "2008-11-13",
        "status": "A",
        "authorized_official_last_name": "LEMIRE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "651-439-2600"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D11236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oneka Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hugo, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.