| NPI | 1083791362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN P LANDE Vice President 612-332-0559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN 7072) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN 7744) |
| 122300000X Dentist (Licence: MN 8119) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-08-22 |