| NPI | 1962645051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA CRAIG Financial Coord 651-750-7273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN 10244) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2021-02-03 |