| NPI | 1831828011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TORIE L MOODIE In House Insurance Specialist 218-359-3210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2022-06-07 |