| NPI | 1104978279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANICE OBERG FREDERICK Owner 612-866-7300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 9631) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2020-08-22 |