Provider Demographics
NPI:1770131401
Name:ST CROIX FAMILY DENTISTRY, SC
Entity type:Organization
Organization Name:ST CROIX FAMILY DENTISTRY, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIN
Authorized Official - Middle Name:SYED
Authorized Official - Last Name:UDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-483-5026
Mailing Address - Street 1:PO BOX 704
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-0704
Mailing Address - Country:US
Mailing Address - Phone:715-483-5026
Mailing Address - Fax:715-483-7066
Practice Address - Street 1:230 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SAINT CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024-4417
Practice Address - Country:US
Practice Address - Phone:715-483-5026
Practice Address - Fax:715-483-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental