| NPI | 1033739248 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORA L NELSON Owner/Dentist 763-639-1291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2020-04-21 |