| NPI | 1083917363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY DAVID HEGGE Owner/President 320-274-2475 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN D11795) |
| Enumeration Date | 2010-12-08 |
| Last Update Date | 2010-12-08 |