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General NPI Number Information
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NPI Number | 1285179945
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Entity Type | Organization
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Legal Business Name | TRUE NORTH ORAL SURGERY AND IMPLANTS PLLC
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Dates
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Enumeration Date | 01/04/2017
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Last Update Date | 04/12/2017
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Provider Practice Location Address
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Address Line | 9950 VALLEY CREEK RD SUITE 100
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City | WOODBURY
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State | MN
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Zip | 55125-4883
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Country | US
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Telephone | 651-578-7000
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Fax | 651-578-0157
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Provider Business Mailing Address
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Address Line | 9950 VALLEY CREEK RD SUITE 100
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City | WOODBURY
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State | MN
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Zip | 55125-4883
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Country | US
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Telephone | 651-578-7000
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Fax | 651-578-0157
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Authorized Official
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Title or Position | ORAL SURGEON/PRESIDENT
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Name | DR. MARSHALL LLOYD WADE
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Credential | D.D.S.
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Telephone | 651-578-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D9734
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License Number State | MN
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