| NPI | 1053614867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSE A HARRISON Manager 952-469-3300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D12108) |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2011-10-17 |