Walleye Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

WALLEYE DENTAL LLC

Practice address

1906 8TH St NW Ste C
Austin, MN 55912-2478

Phone

(949) 403-7044

Fax

(949) 607-4267

NPI assigned

Mar 21, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Caryl L Hollinger

Title

Cfo

Phone

(949) 403-7044

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1742515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742515200000",
    "number": "1922809326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 ARGONAUT STE 220",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926564105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1906 8TH ST NW STE C",
            "city": "AUSTIN",
            "state": "MN",
            "postal_code": "559122478",
            "telephone_number": "949-403-7044",
            "fax_number": "949-607-4267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLEYE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-21",
        "last_updated": "2025-03-21",
        "certification_date": "2025-03-21",
        "status": "A",
        "authorized_official_last_name": "HOLLINGER",
        "authorized_official_first_name": "CARYL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "949-403-7044"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Allen Wagenaar, MS LADC
• Jill Marie Wagner, MS
• Bruce Kevin Waite, D.O.
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• Katherine Wallin, LICSW
• Walmart Inc. (Walmart Pharmacy 10-4257)
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• Dentist in Austin, MN
• Providers in Austin, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.