| NPI | 1730782467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA SMITH Owner/Orthodontist 763-999-0055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2020-11-17 |