| NPI | 1982961942 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARIE T GRADEN Operations 952-891-8630 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN 9488) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2012-04-16 |