Water'S Edge Dental
Organization Active NPI Dental Clinic/Center · Long Lake, MN
NPI 1790146587 · NPPES record last updated Mar 8, 2016
Key facts
- NPI
- 1790146587
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dental Clinic/Center 261QD0000X
- Legal business name
- WATER'S EDGE DENTAL
- Practice address
- 1880 W Wayzata Blvd
Long Lake, MN 55356-9491 - Phone
- (952) 475-0989
- Fax
- (952) 475-2053
- NPI assigned
- Mar 8, 2016
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael E. Giebenhain, D.D.S.
- Title
- Owner
- Phone
- (952) 475-0989
Practitioners 2
-
Anthony Walter Boe, DDS
-
Stephanie Drake, D.D.S.
National Provider Directory
Locations
1880 W Wayzata Blvd
Long Lake, MN 55356
Phone (952) 475-0989
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | Yes |
Addresses
Primary practice location
1880 W Wayzata Blvd
Long Lake, MN 55356-9491
Mailing address
1880 W Wayzata Blvd
P.O.Box 128
Long Lake, MN 55356-9491
Phone (952) 475-0989
Other names
- Lakeside Family Dentistry
Other providers in Long Lake, MN
- Douglas A Smith
- Snyders Drug
- Nicholas Stein
- Paul John Thinesen
- Tonka Life Center, LTD
- Angela Jean Weber
- West Lake Counseling and Wellness, Inc
- Wild Peace Integrative Wellness PLLC
- Amy Michelle Willcockson
All providers in Long Lake, MN · Dental Clinic/Center in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.