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General NPI Number Information
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NPI Number | 1821690496
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Entity Type | Organization
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Legal Business Name | SMILE ORTHODONTICS STILLWATER LLC
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 9424 MAPLE GROVE PKWY N
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City | MAPLE GROVE
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State | MN
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Zip | 55311-5499
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Country | US
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Telephone | 651-351-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 1041 GRAND AVE # 531
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City | SAINT PAUL
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State | MN
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Zip | 55105-3002
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Country | US
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Telephone | 651-351-7777
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Fax |
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Authorized Official
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Title or Position | OWNER/DDS
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Name | DOUGLAS WOLFF
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Credential | DDS
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Telephone | 651-351-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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