| Organization Name: | WATER'S EDGE DENTAL |
| NPI Number: | 1790146587 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL E. GIEBENHAIN (OWNER) |
| Mailing Address: | 1880 W Wayzata Blvd Long Lake |
| State: | MN US |
| Postal Code: | 553569491 |
| Phone Number: | 9524750989 |
| Fax Number: | 9524752053 |
| NPI Enumeration Date: | 03/08/2016 |
| NPI Last Update Date: | 03/08/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |