| NPI | 1417142175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH MARIE SOLTYS LARSON President 612-802-4673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN 11778) |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2009-09-30 |