| NPI | 1467799866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD HOLLY KELLY President 763-420-1030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN 11493) |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2013-01-07 |