| NPI | 1104198837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT WARREN KOUBSKY Owner/Dentist 320-255-9048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 8778) |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2012-01-26 |