| NPI | 1104911056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL KEVIN HODAPP Secretary/Treasurer 218-722-1854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2014-09-04 |