Provider Demographics
NPI:1528597721
Name:EMBRACE ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:EMBRACE ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-257-4445
Mailing Address - Street 1:580 WARNER AVE S
Mailing Address - Street 2:
Mailing Address - City:MAHTOMEDI
Mailing Address - State:MN
Mailing Address - Zip Code:55115-6863
Mailing Address - Country:US
Mailing Address - Phone:651-356-9249
Mailing Address - Fax:
Practice Address - Street 1:13185 SAINT CROIX AVE
Practice Address - Street 2:
Practice Address - City:LINDSTROM
Practice Address - State:MN
Practice Address - Zip Code:55045-9459
Practice Address - Country:US
Practice Address - Phone:651-257-4445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-09
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental