| NPI | 1316035595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE K.A. DORMANEN CEO 763-421-9292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN 8151) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2020-08-22 |