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 |