| NPI | 1124198635 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL PUCEL KOOPMAN Owner 763-428-2226 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D11666) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2020-08-22 |