| NPI | 1932842663 |
|---|---|
| Doing Business As | WOODLAKE ORTHODONTICS LAKE ELMO |
| Entity Type | Organization |
| Authorized Contact | CELIA HAYES Credentialing Coordinator 217-540-2100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2022-04-20 |