| NPI | 1851667364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW EVANS LARSON Owner 651-366-9754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2012-03-29 |