| NPI | 1083874143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACHARY DAVID HAZELTON Dentist 218-333-8668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN D12566) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2008-06-12 |