| NPI | 1649424904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA CRAIG Financial Coord 651-750-7273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN 10890) |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2020-09-15 |