| NPI | 1043429970 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL J CARLSON President 612-333-8677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 11280) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2008-12-10 |