NPIMap

Organization Active NPI

St. Croix Valley Dental, PLLC

Doing business as Rosemount Dental

  • Point of Service
  • Rosemount, MN
National Provider Identifier
1619144540
Registry record updated May 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Point of ServiceTaxonomy code 305S00000X
License
D11236 Issued in MN
Legal business name
ST. CROIX VALLEY DENTAL, PLLC
Doing business as
Rosemount Dental
Practice address
14895 S Robert TRL
Rosemount, MN 55068-3108
Phone
(952) 423-2288
Fax
(952) 423-2203
NPI assigned
May 9, 2008
Last updated
May 9, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2008

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

Authorized official

Name
Douglas S. Wolff, D.D.S.
Title
Owner
Phone
(651) 439-2600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Point of Service 305S00000X D11236 MN Primary
Point of Service 305S00000X D11480 MN

Addresses

Primary practice location

14895 S Robert TRL
Rosemount, MN 55068-3108

Mailing address

14895 S Robert TRL
Rosemount, MN 55068-3108
Phone (952) 423-2288

Other identifiers 5

IdentifierTypeStateIssuer
275435000OtherMNMHCP
071695000OtherWIMHCP
617665000OtherMNMINNESOTA HEALTH CARE PROVIDER
897945000OtherMNMHCP
38396800OtherWIMHCP

Other names 1

  • Rosemount 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.

Locations

14895 S Robert Trl
Rosemount, MN 55068
Phone (952) 423-2288

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1210291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210291200000",
    "number": "1619144540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14895 S ROBERT TRL",
            "city": "ROSEMOUNT",
            "state": "MN",
            "postal_code": "550683108",
            "telephone_number": "952-423-2288",
            "fax_number": "952-423-2203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14895 S ROBERT TRL",
            "city": "ROSEMOUNT",
            "state": "MN",
            "postal_code": "550683108",
            "telephone_number": "952-423-2288",
            "fax_number": "952-423-2203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CROIX VALLEY DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-09",
        "last_updated": "2008-05-09",
        "status": "A",
        "authorized_official_last_name": "WOLFF",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-439-2600",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "MN",
            "license": "D11236",
            "primary": true
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "MN",
            "license": "D11480",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHCP",
            "identifier": "275435000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHCP",
            "identifier": "071695000",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA HEALTH CARE PROVIDER",
            "identifier": "617665000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHCP",
            "identifier": "897945000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHCP",
            "identifier": "38396800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rosemount Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rosemount, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 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.