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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