| NPI | 1659447670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYDIA JONAK Office Manager 763-757-2768 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN 9570) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2020-08-22 |