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General NPI Number Information
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NPI Number | 1407613375
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Entity Type | Organization
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Legal Business Name | WISE OPTION DENTAL PLLC
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Dates
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Enumeration Date | 03/06/2024
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 10653 WAYZATA BLVD STE 200
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City | MINNETONKA
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State | MN
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Zip | 55305-1543
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Country | US
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Telephone | 612-578-8893
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Fax |
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Provider Business Mailing Address
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Address Line | 320 CALAMUS CIR
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City | MEDINA
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State | MN
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Zip | 55340-9228
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | KIRBY JOHNSON
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Credential | DDS
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Telephone | 612-834-2512
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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 |
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License Number State |
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