ST. CROIX VALLEY DENTAL, PLLC (NPI# 1619144540) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619144540 |
| Entity Type | Organization |
| Organization Name | ST. CROIX VALLEY DENTAL, PLLC |
| Other Organization Name | ROSEMOUNT DENTAL |
| Practice Address |
14895 S Robert Trl Rosemount MN 55068-3108 |
| Practice Telephone | 9524232288 |
| Practice Fax Number | 9524232203 |
| Mailing Telephone | 9524232288 |
| Mailing Fax Number | 9524232203 |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2008-05-09 |
| Authorized Official Name | DOUGLAS S. WOLFF (OWNER) |
| Authorized Official Telephone | 6514392600 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 305S00000X | Point of Service | D11480 | MN | Managed Care Organizations |
| Y | 305S00000X | Point of Service | D11236 | MN | Managed Care Organizations |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | MHCP | 275435000 | 01 |
| MN | MINNESOTA HEALTH CARE PROVIDER | 617665000 | 01 |
| WI | MHCP | 38396800 | 01 |
| MN | MHCP | 897945000 | 01 |
| WI | MHCP | 071695000 | 01 |
| Other Name | Type Code |
|---|---|
| Rosemount Dental | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265618862 | St. Croix Valley Dental, Pllc | Point of Service | 1003 Pearson Dr., Hudson, WI 54016 | 2008-01-14 |
| 1740259464 | St. Croix Valley Dental, Pllc | Dentist | 13961 60th St. North, Stillwater, MN 55082 | 2006-03-15 |
| 1689842841 | St. Croix Valley Dental, Pllc | Dentist | 13961 60th St N, Stillwater, MN 55082-1053 | 2008-02-11 |
| Street Address |
14895 S ROBERT TRL |
| City | ROSEMOUNT |
| State | MN |
| Zip Code | 55068-3108 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134323280 | Brandon J Ranvek | Dentist | 14895 S Robert Trl, Rosemount, MN 55068-3108 | 2007-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740744911 | Scott Hogan | Chiropractor | 2930 146th St. W #110, Rosemount, MN 55068 | 2019-01-22 |
| 1184133357 | Green Medical Solutions | Durable Medical Equipment & Medical Supplies | 15170 Chippendale Ave W., Suite 101, Rosemount, MN 55068 | 2017-09-20 |
| 1215382767 | Jessica Warren | Chiropractor | 15170 Chippendale Ave S, Suite 200, Rosemount, MN 55068 | 2016-05-03 |
| 1033596275 | Leslie Wight | Marriage & Family Therapist | 2930 146th St. W, #114, Rosemount, MN 55068 | 2015-04-27 |
| 1871914044 | Jeanine Martin | Occupational Therapy Assistant | 2930 146th St W Apt 239, Rosemount, MN 55068 | 2013-12-13 |
| 1699097394 | Colleen Renee Mens | Social Worker | 15170 Chippendale Ave W Ste 300, Rosemount, MN 55068 | 2010-02-22 |
| 1306005111 | Jaclyn J Bohm | Podiatrist | 15705 Cimarron Ave, Rosemount, MN 55068 | 2008-06-06 |
| 1619185196 | John J Benson | Marriage & Family Therapist | 14555 South Robert Trl, Rosemount, MN 55068 | 2007-05-18 |
| 1316062557 | Orthodontic Care Group | Dentist | 14455 South Robert Trail, Inver Grove Heights, MN 55068 | 2007-03-20 |
| 1063400901 | Mark John Nelson | Dentist | 14450 S Rober Tr, Dakota Dental and Implant Center, Rosemount, MN 55068 | 2005-10-13 |
| Find all providers in zip 55068 | ||||
| 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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| 1184082471 | Asian Chiropractic Inc. | Point of Service | 7827 Brooklyn Blvd, Brooklyn Park, MN 55445-2716 | 2016-02-02 |
| 1841613064 | Global Lynx, LLC | Point of Service | 1415 Arcade St, Suite 202, Saint Paul, MN 55106-1822 | 2014-01-23 |
| 1487076238 | Chatters Lumber Inc | Point of Service | 4715 17th Ave S, Minneapolis, MN 55407-3613 | 2014-01-14 |
| 1497193536 | Annur Clinic LLC | Point of Service | 1729 Lyndale Ave N, Minneapolis, MN 55411-3349 | 2013-06-11 |
| 1982945184 | Premeir Home Healthcare | Point of Service | 612 E 27th St, Minneapolis, MN 55407-1002 | 2013-03-13 |
| 1164700076 | Sound Solutions Hearing Centers of Minnesota LLC. | Point of Service | 4101 W Division St Ste 4, Saint Cloud, MN 56301-3729 | 2011-07-26 |
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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.