Provider Demographics
NPI:1790389005
Name:ST. CROIX ENDODONTICS
Entity Type:Organization
Organization Name:ST. CROIX ENDODONTICS
Other - Org Name:ST. CROIX ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-767-9119
Mailing Address - Street 1:11855 ULYSSES ST NE STE 260
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-4182
Mailing Address - Country:US
Mailing Address - Phone:763-767-9119
Mailing Address - Fax:
Practice Address - Street 1:11855 ULYSSES ST NE STE 260
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4182
Practice Address - Country:US
Practice Address - Phone:763-767-9119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-27
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty