NPI | 1043509425 |
---|---|
Entity Type | Organization |
Authorized Contact | LINDA MARIE JORGENSON Program Director 651-779-3983 |
Organization Subpart ? | Yes |
Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN H1557) |
Enumeration Date | 2011-04-06 |
Last Update Date | 2011-04-06 |