| Travis W. Wille, DDS, MS | |
|
25 Lake St N Suite 135 Forest Lake MN 55025-2535 | |
| (651) 464-1151 | |
| (651) 464-0620 |
| Full Name | Travis W. Wille, DDS, MS |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 25 Lake St N, Forest Lake, Minnesota |
| Authorized Official Name and Position | Travis W Wille (PRESIDENT/ORTHODONTIST) |
| Authorized Official Contact | 6514641151 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Travis W. Wille, DDS, MS 25 Lake St N Suite 135 Forest Lake MN 55025-2535 Ph: (651) 464-1151 | Travis W. Wille, DDS, MS 25 Lake St N Suite 135 Forest Lake MN 55025-2535 Ph: (651) 464-1151 |
| NPI Number | 1023452638 |
|---|---|
| Provider Enumeration Date | 04/25/2013 |
| Last Update Date | 04/25/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023452638 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (NU) | Primary |
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