Provider Demographics
NPI:1285179945
Name:TRUE NORTH ORAL SURGERY AND IMPLANTS PLLC
Entity Type:Organization
Organization Name:TRUE NORTH ORAL SURGERY AND IMPLANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-578-7000
Mailing Address - Street 1:9950 VALLEY CREEK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4883
Mailing Address - Country:US
Mailing Address - Phone:651-578-7000
Mailing Address - Fax:651-578-0157
Practice Address - Street 1:9950 VALLEY CREEK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4883
Practice Address - Country:US
Practice Address - Phone:651-578-7000
Practice Address - Fax:651-578-0157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND97341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty