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 |