| NPI | 1083837199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY L. SODERSTROM President 605-388-0930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SD M537) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2020-08-22 |