| NPI | 1164040457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN COLBY Owner 952-831-1324 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2020-07-13 |