Healthcare Provider Details

I. General information

NPI: 1992716062
Provider Name (Legal Business Name): WAYNE ARTHUR FINNEGAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3507 ROUND LAKE BLVD NW SUITE 700
ANOKA MN
55303-5001
US

IV. Provider business mailing address

34617 COUNTY 12
LANESBORO MN
55949-8238
US

V. Phone/Fax

Practice location:
  • Phone: 763-323-7677
  • Fax: 763-323-7282
Mailing address:
  • Phone: 507-765-5371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7417
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: