| NPI | 1114514205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE NORDEEN Owner 952-715-6177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-12-23 |
| Last Update Date | 2020-12-23 |