| NPI | 1144599135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TORI CONRAD President 612-834-1664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN D12562) |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2011-12-20 |