| NPI | 1649438268 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH ROBERT ERICKSON President 651-405-1055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN D9558) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2008-05-30 |