| NPI | 1134574163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOSSEIN A JALALI Owner 651-633-1311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 10256) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D13480) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN 10465) | |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2016-04-27 |