Provider Demographics
NPI:1902087554
Name:DOUGLAS W. VAYDA DDS
Entity Type:Organization
Organization Name:DOUGLAS W. VAYDA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-445-7700
Mailing Address - Street 1:1335 10TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-2901
Mailing Address - Country:US
Mailing Address - Phone:952-445-7700
Mailing Address - Fax:
Practice Address - Street 1:1335 10TH AVE E
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-2901
Practice Address - Country:US
Practice Address - Phone:952-445-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty