St. Croix Endodontics

Primary specialty

EndodonticsTaxonomy code 1223E0200X

Legal business name

ST. CROIX ENDODONTICS

Practice address

25 Lake St N
Suite 110
Forest Lake, MN 55025-2535

Phone

(651) 464-7388

Fax

(651) 982-6236

NPI assigned

Dec 15, 2014

Last updated

Nov 23, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Serena Jean Pedersen

Title

Office Manager

Phone

(763) 767-9119

Specialties & licenses 1

Addresses

Tax ID family

St Croix Endodontics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• St. Croix Endodontics

  • Endodontics
  • Blaine, MN
  • NPI 1790389005
  NPD tax ID

Locations

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

{
    "created_epoch": "1418601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606089600000",
    "number": "1952709420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 LAKE ST N",
            "address_2": "SUITE 110",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550252535",
            "telephone_number": "651-464-7388",
            "fax_number": "651-982-6236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 LAKE ST N",
            "address_2": "SUITE 110",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550252535",
            "telephone_number": "651-464-7388",
            "fax_number": "651-982-6236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CROIX ENDODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-15",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A",
        "authorized_official_last_name": "PEDERSEN",
        "authorized_official_first_name": "SERENA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "763-767-9119"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine Lynn Sparboe, RDN
• Spehar Guiding LLC
• Jacob Louis Spehar, MA, LPCC, LADC
• Heidi Marie Spetzman, LAMFT
• Diane Marie Spiess, PTA
• Charlotte Louise Stack, R.N., CNS
• William Howard Stackpole, DDS
• Edward J Stec, D.D.S, M.S
• Rodney A Stensrud, DDS
• Connie Renee Stoner

• Endodontics in Forest Lake, MN
• Providers in Forest Lake, MN by specialty
• Endodontics in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 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.