Organization
WILD CHILD ORTHODONTICS
Active
Other names
Veil & Wild Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN WILD DDS (DOCTOR)
(952) 903-9484
Entity
Organization
Contact information
Practice address
17677 CEDAR AVE, LAKEVILLE, MN 55044-2250
(952) 903-9484
(952) 941-7091
Mailing address
11800 SINGLETREE LN STE 200, EDEN PRAIRIE, MN 55344-5397
(952) 903-9484
(952) 941-7091
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/31/2023
Last updated
05/31/2023
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