| NPI | 1073862819 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH BRUCE WEDDELL Owner 952-884-7706 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D12619) |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2023-08-09 |