Organization
EDEN PRAIRIE ORTHODONTIC ASSOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE SCHULTZ (OFFICE MANAGER)
(952) 829-0686
Entity
Organization
Contact information
Practice address
8200 COMMONWEALTH DR # 100, EDEN PRAIRIE, MN 55344-5365
(952) 829-0686
Mailing address
8200 COMMONWEALTH DR # 100, EDEN PRAIRIE, MN 55344-5365
(952) 829-0686
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
07/14/2020
Last updated
07/14/2020
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