Healthcare Provider Details

I. General information

NPI: 1447197280
Provider Name (Legal Business Name): WABASHA DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 MAIN ST W
WABASHA MN
55981-1238
US

IV. Provider business mailing address

207 MAIN ST W
WABASHA MN
55981-1238
US

V. Phone/Fax

Practice location:
  • Phone: 651-565-3511
  • Fax: 651-565-2224
Mailing address:
  • Phone: 651-565-3511
  • Fax: 651-565-2224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT HOLT DURAND
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 651-262-8735