Provider Demographics
NPI:1093931446
Name:SLETTEN, WAYNE ORVILLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ORVILLE
Last Name:SLETTEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007
Mailing Address - Country:US
Mailing Address - Phone:507-373-1915
Mailing Address - Fax:507-373-1254
Practice Address - Street 1:1206 W FRONT ST
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007
Practice Address - Country:US
Practice Address - Phone:507-373-1915
Practice Address - Fax:507-373-1254
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND70151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics