| NPI | 1801991146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA V ROSS Owner 952-922-7117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN 9941) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2020-08-22 |