Organization
WAYZATA ENDODONTICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY VINCENT OTOOLE DDS MS (PRESIDENT)
(952) 476-0070
Entity
Organization
Contact information
Practice address
250 N CENTRAL AVE, SUITE 303, WAYZATA, MN 55391
(952) 476-0070
Mailing address
250 N CENTRAL AVE, SUITE 303, WAYZATA, MN 55391
(952) 476-0070
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
11543
MN
1223E0200X
Endodontics
Primary
9011
MN
Other
Enumeration date
12/09/2006
Last updated
08/22/2020
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