| NPI | 1083792279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIRLEY HERDING Office Manager 651-437-3262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2008-11-19 |