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General NPI Number Information
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NPI Number | 1699204172
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Entity Type | Organization
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Legal Business Name | WLD2, LLC
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 06/08/2017
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Provider Practice Location Address
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Address Line | 132 PIONEER TRL
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City | CHASKA
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State | MN
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Zip | 55318-1167
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Country | US
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Telephone | 952-361-3740
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Fax |
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Provider Business Mailing Address
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Address Line | 1635 SUNNYBROOK CIR
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City | MINNETRISTA
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State | MN
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Zip | 55364-1276
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Country | US
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Telephone | 16123875009
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHANIE LYNN MINER
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Credential | DDS
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Telephone | 612-387-5009
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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 | D11974
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License Number State | MN
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