| NPI | 1013988765 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VACHAREE SRISWAD PETERSON President 651-774-2959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 129322200) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2020-08-22 |