| NPI | 1720508179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TORIE L MOODIE In House Insurance Specialist 218-236-1322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN S36) |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2018-03-17 |