Healthcare Provider Details

I. General information

NPI: 1528597721
Provider Name (Legal Business Name): EMBRACE ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 06/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13185 SAINT CROIX AVE
LINDSTROM MN
55045-9459
US

IV. Provider business mailing address

580 WARNER AVE S
MAHTOMEDI MN
55115-6863
US

V. Phone/Fax

Practice location:
  • Phone: 651-257-4445
  • Fax:
Mailing address:
  • Phone: 651-356-9249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ESTEE WANG
Title or Position: CO-OWNER/ORTHODONTIST
Credential:
Phone: 651-257-4445