| NPI | 1073787669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARL ANDREW ANDRESON Owner 651-735-4661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MN D9208) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D7091) |
| 1223G0001X Dentist, General Practice (Licence: MN D9766) | |
| 1223P0300X Dentist, Periodontics (Licence: MN D12228) | |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2008-04-15 |