| NPI | 1902087554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY SELLNER Office Manager 952-445-7700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2007-11-23 |
| Last Update Date | 2010-05-20 |