Organization
WLD2, LLC
Active
Parent organization
WEST LAKES DENTISTRY, PA
Other names
West Lakes Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
WEST LAKES DENTISTRY, PA
Authorized official
DR. STEPHANIE LYNN MINER DDS (PRESIDENT)
(612) 387-5009
Entity
Organization
Contact information
Practice address
132 PIONEER TRL, CHASKA, MN 55318-1167
(952) 361-3740
Mailing address
1635 SUNNYBROOK CIR, MINNETRISTA, MN 55364-1276
16123875009
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D11974
MN
Other
Enumeration date
06/08/2017
Last updated
06/08/2017
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