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SOUTH RIVER DENTAL PLLC
NPI 1154066405
Clinic/Center - Dental in West St Paul, MN

Active since May 02, 2022
1545 LIVINGSTON AVE STE 101, WEST ST PAUL, MN 55118(651) 455-0505 Get Directions Write a Review

NPPES record last updated: May 2, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About South River Dental Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTH RIVER DENTAL PLLC (NPI 1154066405) is a healthcare organization registered as a dental in West St Paul, Minnesota and active in the NPI registry since May 2022. The organization lists Clint Matthew Kroeker, President, as its authorized official.

NPPES Registry Identity

NPI1154066405
Entity TypeOrganization
Primary Taxonomy261QD0000X
Legal Business NameSOUTH RIVER DENTAL PLLC
Location Address1545 LIVINGSTON AVE STE 101West St Paul, MN 55118-3422
Mailing Address1545 Livingston Ave Ste 101West St Paul, MN 55118-3422 · (651) 455-0505
Phone(651) 455-0505
Organization SubpartNo
Authorized OfficialClint Matthew KroekerPresident · (651) 455-0505
Enumeration DateMay 2, 2022
NPPES CertifiedMay 2, 2022
✔ NPI 1154066405 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · DentalAmbulatory Health Care Facilities
Taxonomy Code261QD0000X
1545 LIVINGSTON AVE STE 101, West St Paul, MN 55118
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Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CLINT MATTHEW KROEKER DDS
Dentist (General Practice)
1545 LIVINGSTON AVE STE 101
WEST ST PAUL, MN 55118
Dakota County (651) 455-0505

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is South River Dental PLLC's NPI number?

The NPI number for South River Dental PLLC is 1154066405. It was assigned to this organization in the NPPES registry on May 2, 2022.

Where is South River Dental PLLC located?

South River Dental PLLC is located at 1545 Livingston Ave Ste 101, West St Paul, MN 55118. The listed phone number is (651) 455-0505.

What is South River Dental PLLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Dental, with taxonomy code 261QD0000X.

When was this NPI record last updated?

The NPPES record for South River Dental PLLC was last updated on May 2, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.