Provider Demographics
NPI:1295846996
Name:WAINIO, JOHN DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:WAINIO
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 1:5180 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-9483
Mailing Address - Country:US
Mailing Address - Phone:218-721-3820
Mailing Address - Fax:
Practice Address - Street 1:2730 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-6710
Practice Address - Country:US
Practice Address - Phone:218-722-1846
Practice Address - Fax:218-722-3552
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND73661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice