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 |