Provider Demographics
NPI:1730310442
Name:WAYNE O SLETTEN DDS MSD PA
Entity Type:Organization
Organization Name:WAYNE O SLETTEN DDS MSD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:ORVILLE
Authorized Official - Last Name:SLETTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-238-4512
Mailing Address - Street 1:1235 HIGHWAY 15 S
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4461
Mailing Address - Country:US
Mailing Address - Phone:507-238-4512
Mailing Address - Fax:507-238-4609
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:56007-1903
Practice Address - Country:US
Practice Address - Phone:507-373-1915
Practice Address - Fax:507-373-1254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN70151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty