| NPI | 1053791319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACHARY WALGENBACH Dentist 763-784-1993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 13515) |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2015-09-11 |