Provider Demographics
NPI:1508833898
Name:WAVRIN, DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:WAVRIN
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 1:207 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LE SUEUR
Mailing Address - State:MN
Mailing Address - Zip Code:56058-1912
Mailing Address - Country:US
Mailing Address - Phone:507-665-3266
Mailing Address - Fax:507-665-3261
Practice Address - Street 1:207 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LE SUEUR
Practice Address - State:MN
Practice Address - Zip Code:56058-1912
Practice Address - Country:US
Practice Address - Phone:507-665-3266
Practice Address - Fax:507-665-3261
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN78511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice