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General NPI Number Information
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NPI Number | 1528597721
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Entity Type | Organization
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Legal Business Name | EMBRACE ORTHODONTICS PLLC
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Dates
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Enumeration Date | 06/09/2017
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Last Update Date | 06/09/2017
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Provider Practice Location Address
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Address Line | 13185 SAINT CROIX AVE
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City | LINDSTROM
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State | MN
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Zip | 55045-9459
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Country | US
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Telephone | 651-257-4445
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Fax |
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Provider Business Mailing Address
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Address Line | 580 WARNER AVE S
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City | MAHTOMEDI
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State | MN
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Zip | 55115-6863
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Country | US
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Telephone | 651-356-9249
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/ORTHODONTIST
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Name | DR. ESTEE WANG
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Credential |
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Telephone | 651-257-4445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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