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General NPI Number Information
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NPI Number | 1063172468
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Entity Type | Organization
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Legal Business Name | STAPLES SMILES
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Dates
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Enumeration Date | 12/27/2021
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 515 6TH ST NE
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City | STAPLES
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State | MN
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Zip | 56479-2359
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Country | US
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Telephone | 218-894-1941
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Fax | 218-894-5729
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Provider Business Mailing Address
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Address Line | 515 6TH ST NE
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City | STAPLES
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State | MN
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Zip | 56479-2359
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Country | US
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Telephone | 218-894-1941
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Fax | 218-894-5729
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. LUKE E WALN
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Credential | DDS
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Telephone | 218-963-6330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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