| NPI | 1083849558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSEMARY WALLACE Office Manager 612-788-5151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 10006) |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2009-05-27 |