| NPI | 1306185160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE KOOP Office Mgr 218-722-4484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MN 11345) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MN 12487) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MN 12454) | |
| Enumeration Date | 2013-02-13 |
| Last Update Date | 2013-02-13 |