| NPI | 1538225677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY LEROY CARLSON President 952-474-3203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MN D6852) |
| Enumeration Date | 2006-12-30 |
| Last Update Date | 2020-08-22 |