| NPI | 1457969636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE SCHULTZ Office Manager 952-829-0686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2020-07-14 |