| NPI | 1063559540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENNETT ISABELLA President 952-431-5774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D9428) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2019-08-15 |