| NPI | 1720146111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY AM NORDIN Business Manager 320-255-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN 11705) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN 8228) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN D12904) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2011-08-19 |