| NPI | 1831382134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN K VAN LAECKEN Owner 605-882-2772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SD M817) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2007-08-21 |