| NPI | 1073970273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANIEL COGSWELL Treasurer/Secretary 651-644-3685 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D13398) |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2016-01-20 |