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Organization
WATER'S EDGE DENTAL
Active
Organization
WATER'S EDGE DENTAL
Active
Other names
Lakeside Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL E. GIEBENHAIN D.D.S. (OWNER)
(952) 475-0989
Entity
Organization
Contact information
Practice address
1880 W WAYZATA BLVD, LONG LAKE, MN 55356-9491
(952) 475-0989
(952) 475-2053
Mailing address
1880 W WAYZATA BLVD, P.O.BOX 128, LONG LAKE, MN 55356-9491
(952) 475-0989
(952) 475-2053
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/08/2016
Last updated
03/08/2016
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