| NPI | 1104126168 |
|---|---|
| Doing Business As | DISTINCTIVE DENTAL |
| Entity Type | Organization |
| Authorized Contact | CHARLES N MILLER President 612-718-3149 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D10738) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D7255) |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2013-07-11 |