| NPI | 1700940343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN J RENNER Accountant 952-933-8444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MN 7094) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2020-08-22 |