| NPI | 1043265481 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL SHAWN NANNE Owner President 952-892-7700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 10615) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2020-08-22 |