| NPI | 1053591255 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOLLY SEIDL Office Manager 651-482-1122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN 9142) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: MN 12387) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2007-11-06 |