Organization
IMAGINE ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SARAH MARIE SOLTYS LARSON DDS (PRESIDENT)
(612) 802-4673
Entity
Organization
Contact information
Practice address
14020 NORTHDALE BLVD, ROGERS, MN 55374-9612
(763) 428-1912
Mailing address
14096 STARLITE DR, ROGERS, MN 55374-5812
(763) 428-1912
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
11778
MN
Other
Enumeration date
09/06/2007
Last updated
09/30/2009
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