| NPI | 1417115189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH ROBERT ERICKSON President 651-426-3873 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN D9558) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2008-05-29 |