| Imagine Orthodontics | |
|
14020 Northdale Blvd Rogers MN 55374-9612 | |
| (763) 428-1912 | |
| Not Available |
| Full Name | Imagine Orthodontics |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 14020 Northdale Blvd, Rogers, Minnesota |
| Authorized Official Name and Position | Sarah Marie Soltys Larson (PRESIDENT) |
| Authorized Official Contact | 6128024673 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Imagine Orthodontics 14096 Starlite Dr Rogers MN 55374-5812 Ph: (763) 428-1912 | Imagine Orthodontics 14020 Northdale Blvd Rogers MN 55374-9612 Ph: (763) 428-1912 |
| NPI Number | 1417142175 |
|---|---|
| Provider Enumeration Date | 09/06/2007 |
| Last Update Date | 09/30/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417142175 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 11778 (Minnesota) | Primary |
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