| NPI | 1356967061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSEMARY LELICH Orthodontist 612-309-2322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2020-06-18 |