Organization
EVOLVE ORTHODONTICS PLLC
Active
Other names
Evolve Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DUSTIN MATTHEW DITCH DDS (OWNER)
(612) 804-4028
Entity
Organization
Contact information
Practice address
510 22ND AVE E STE 702, ALEXANDRIA, MN 56308-4653
(612) 804-4028
Mailing address
41625 BUR OAK HILLS RD, PELICAN RAPIDS, MN 56572-7448
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D13650
MN
Other
Enumeration date
01/24/2018
Last updated
01/24/2018
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