| NPI | 1104864529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATTY BARNARD Business Manager 651-233-2140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D11177) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D11556) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 3029015) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 5898015) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 5897015) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D9744) | |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2022-09-23 |