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NPI Code Detail

MEDICARE: SMILE ORTHODONTICS STILLWATER LLC

MEDICARE: SMILE ORTHODONTICS STILLWATER LLC
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
11223X0400XOrthodontics and Dentofacial Orthopedics DentistryD11236MN

General Provider Information

NPI Number : 1356854442
Entity Type Code : Organization
Provider Name (Legal Business Name) : SMILE ORTHODONTICS STILLWATER LLC
Provider Business Mailing Address
First Line : 1041 GRAND AVE # 531
Second Line :
City : SAINT PAUL
State : MN
Zip : 55105-3002
Country : US
Telephone Number : 651-351-7777
Fax Number :
Provider Business Practice Location Address
First Line : 2224 HENNEPIN AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55405-2737
Country : US
Telephone Number : 651-351-7777
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : DR. DOUGLAS STEVEN WOLFF
Credential : DDS
Telephone Number : 651-351-7777
Provider Enumeration Date : 11/10/2017
Last Update Date : 12/10/2025

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Directions to “SMILE ORTHODONTICS STILLWATER LLC ” Practice Location

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