Healthcare Provider Details

I. General information

NPI: 1508833898
Provider Name (Legal Business Name): DENNIS WAVRIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/05/2006
Last Update Date: 11/23/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S MAIN ST
LE SUEUR MN
56058-1912
US

IV. Provider business mailing address

207 S MAIN ST
LE SUEUR MN
56058-1912
US

V. Phone/Fax

Practice location:
  • Phone: 507-665-3266
  • Fax: 507-665-3261
Mailing address:
  • Phone: 507-665-3266
  • Fax: 507-665-3261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7851
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: