ST. CROIX VALLEY DENTAL, PLLC (NPI# 1265618862) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265618862 |
| Entity Type | Organization |
| Organization Name | ST. CROIX VALLEY DENTAL, PLLC |
| Other Organization Name | DBA/ CARMICHAEL DENTAL |
| Practice Address |
1003 Pearson Dr. Hudson WI 54016 |
| Mailing Address |
13961 60th St North Stillwater MN 55082 |
| Practice Telephone | 7153779966 |
| Practice Fax Number | 7153779933 |
| Mailing Telephone | 6514392600 |
| Mailing Fax Number | 6514392600 |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2008-08-20 |
| Authorized Official Name | DOUGLAS S. WOLFF (PWNER) |
| Authorized Official Telephone | 6514392600 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | Y |
| Parent Organization Name | ST. CROIX VALLEY DENTAL, PLLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305S00000X | Point of Service | ========= | WI | Managed Care Organizations |
| Other Name | Type Code |
|---|---|
| DBA/ Carmichael Dental | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740259464 | St. Croix Valley Dental, Pllc | Dentist | 13961 60th St. North, Stillwater, MN 55082 | 2006-03-15 |
| 1619144540 | St. Croix Valley Dental, Pllc | Point of Service | 14895 S Robert Trl, Rosemount, MN 55068-3108 | 2008-05-09 |
| 1689842841 | St. Croix Valley Dental, Pllc | Dentist | 13961 60th St N, Stillwater, MN 55082-1053 | 2008-02-11 |
| Street Address |
1003 PEARSON DR. |
| City | HUDSON |
| State | WI |
| Zip Code | 54016 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164921128 | Sara Lynn Henry | Occupational Therapy Assistant | 1320 Wisconsin St., Husdon, WI 54016 | 2018-02-06 |
| 1689003436 | Serving Hands Inc | Home Health | 1419 Boulder Court, Hudson, WI 54016 | 2013-11-02 |
| 1275973042 | Lisa Renee Haverly | Occupational Therapist | 477 Perch Lake Rd, Hudson, WI 54016 | 2013-06-26 |
| 1710320213 | Emily Ann Stevenson | Counselor | 901 4th St Ste 165, Hudson, WI 54016 | 2013-04-15 |
| 1083972954 | The Shurden Group | In Home Supportive Care | 2424 Monetary Blvd. #012, The Shurden Group Dba Comfort Keepers, Hudson, WI 54016 | 2012-04-30 |
| 1124305933 | Robert Michael Catlow-price | Massage Therapist | 131 Carmichael Road, Suite #202, Hudson, WI 54016 | 2011-11-08 |
| 1962780221 | Qin Chu | Acupuncturist | 1615 Maxwell Dr., Suite D, Hudson, WI 54016 | 2011-08-03 |
| 1124324231 | Hung Trieu Lieu | Acupuncturist | 1810 Crest View Dr Ste 4a, Hudson, WI 54016 | 2011-02-07 |
| 1912214966 | Sumac Residential LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 723 B Blue Jay Lane, Hudson, WI 54016 | 2010-09-10 |
| 1740593201 | Michelle Marie Young | Counselor | 2501 Hanley Road, Suite F, Eagle Valley Bank Building, Hudson, WI 54016 | 2010-07-26 |
| Find all providers in zip 54016 | ||||
| Taxonomy Code | 305S00000X |
| Grouping | Managed Care Organizations |
| Classification | Point of Service |
| This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 62 |
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|---|---|---|---|---|
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| 1881815587 | Columbus Dental Care, Pllc | Point of Service | 30 Lowell Rd, Suite #19, Hudson, NH 03051-2800 | 2007-05-01 |
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| 1235502493 | The Smith LLC | Point of Service | 9545 S 20th St Ste 2, Oak Creek, WI 53154-4929 | 2015-11-09 |
| 1992185631 | Care for All Ages | Point of Service | 1308 S Norwood Ave, Green Bay, WI 54304-1001 | 2015-06-08 |
| 1467847509 | Health Grades | Point of Service | 2927 Coho St, Madison, WI 53713-3069 | 2015-04-06 |
| 1326449604 | Soul To Soul Massage LLC | Point of Service | 604 E 3rd St, Marshfield, WI 54449-4511 | 2014-09-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.