| NPI | 1013153352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE LOFT Site Manager 651-488-5557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN d11202) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN 11152) |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2008-12-16 |