| NPI | 1316097116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE M ALICK Dds, Ms 952-937-0111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2020-08-22 |