| NPI | 1093261190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID S GESKO Senior VP/ Dental Director 952-883-7577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN 10265) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MN 11843) |
| 1223G0001X Dentist, General Practice (Licence: MN 11843) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MN 11316) | |
| 1223P0300X Dentist, Periodontics (Licence: MN 10028) | |
| 1223P0700X Dentist, Prosthodontics (Licence: MN 10265) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN 11315) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN 9812) | |
| 125Q00000X Oral Medicinist (Licence: MN 12047) | |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2016-08-29 |