| NPI | 1053807016 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VACHAREE SRISWAD PETERSON Dentist 651-779-4195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN D9309) |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2018-07-02 |