Provider Demographics
NPI:1063172468
Name:STAPLES SMILES
Entity type:Organization
Organization Name:STAPLES SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WALN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-963-6330
Mailing Address - Street 1:515 6TH ST NE
Mailing Address - Street 2:
Mailing Address - City:STAPLES
Mailing Address - State:MN
Mailing Address - Zip Code:56479-2359
Mailing Address - Country:US
Mailing Address - Phone:218-894-1941
Mailing Address - Fax:218-894-5729
Practice Address - Street 1:515 6TH ST NE
Practice Address - Street 2:
Practice Address - City:STAPLES
Practice Address - State:MN
Practice Address - Zip Code:56479-2359
Practice Address - Country:US
Practice Address - Phone:218-894-1941
Practice Address - Fax:218-894-5729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty