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General NPI Number Information
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NPI Number | 1013717289
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Entity Type | Organization
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Legal Business Name | WOODS AND WATER FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 505 COMMERCE WAY
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City | CLOQUET
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State | MN
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Zip | 55720-5572
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Country | US
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Telephone | 218-310-4944
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Fax |
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Provider Business Mailing Address
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Address Line | 23 THOMSON RD
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City | ESKO
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State | MN
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Zip | 55733-9632
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Country | US
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Telephone | 218-310-4944
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. WENDY PETERSON
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Credential | DMD
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Telephone | 218-310-4944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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