| NPI | 1104906379 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JAY ROSCHER Owner 651-459-2387 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN MN8121) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2010-06-22 |