MEDICARE: DR. NGOC MY WAITE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D10605	MN

General Provider Information

NPI Number	:	1043201353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NGOC MY WAITE DDS

Provider Business Mailing Address
First Line	:	6300 SHINGLE CREEK PKWY
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-2191
Country	:	US
Telephone Number	:	763-560-4081
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 SHINGLE CREEK PKWY
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-2124
Country	:	US
Telephone Number	:	763-560-4081
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	07/08/2007

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