| NPI | 1194101055 |
|---|---|
| Former Legal Business Name | WAYZATA SMILES |
| Entity Type | Organization |
| Authorized Contact | BRUCE J MARTINSON Dentist/ Owner 952-473-4639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D9301) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2015-08-03 |