| NPI | 1306901814 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY LYNN LANGSJOEN Treasurer 320-255-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN 11705) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN S-9) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN 8228) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2020-08-22 |