| NPI | 1104089291 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESIREE M MORK Dentist/Owner 507-452-5214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D12582) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D12583) |
| 1223G0001X Dentist, General Practice (Licence: MN 08682) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2008-08-12 |