NPIMap

Organization Active NPI

St Croix Valley Dental PLLC

  • Dentist
  • Lake Elmo, MN
National Provider Identifier
1891885000
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
ST CROIX VALLEY DENTAL PLLC
Practice address
11240 Stillwater Blvd N
Lake Elmo, MN 55128
Phone
(651) 777-0210
Fax
(651) 777-0320
NPI assigned
Oct 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Douglas Steven Wolff, DDS
Title
Owner Dentist
Phone
(651) 777-0210

Specialties & licenses 1

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

Addresses

Primary practice location

11240 Stillwater Blvd N
Lake Elmo, MN 55128

Mailing address

11240 Stillwater Blvd N
Lake Elmo, MN 55042
Phone (651) 777-0210

Other names 1

  • Lake Elmo 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": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891885000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11240 STILLWATER BLVD N",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "55042",
            "telephone_number": "651-777-0210",
            "fax_number": "651-777-0320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11240 STILLWATER BLVD N",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "55128",
            "telephone_number": "651-777-0210",
            "fax_number": "651-777-0320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CROIX VALLEY DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WOLFF",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "651-777-0210",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Elmo Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Elmo, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.