Healthcare Provider Details

I. General information

NPI: 1972670206
Provider Name (Legal Business Name): DANIEL WAYNE SLETTEN D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 OSGOOD AVE N SUITE 205
STILLWATER MN
55082-6101
US

IV. Provider business mailing address

3344 BARONS WAY
STILLWATER MN
55082-4799
US

V. Phone/Fax

Practice location:
  • Phone: 651-439-3350
  • Fax:
Mailing address:
  • Phone: 651-430-3839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD11561
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: