Provider Demographics
NPI:1407131618
Name:ST. CROIX KIDDS PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:ST. CROIX KIDDS PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:RINDELAUB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-808-0460
Mailing Address - Street 1:400 2ND ST S
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-4000
Mailing Address - Country:US
Mailing Address - Phone:715-808-0460
Mailing Address - Fax:715-808-0142
Practice Address - Street 1:4951 MOREHEAD AVE
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-2633
Practice Address - Country:US
Practice Address - Phone:651-324-4270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6666-0151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty