| NPI | 1033170857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAYNE F. GROUT Office Manager 651-227-6561 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 9068) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2020-08-22 |