| NPI | 1154522373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIRLEY HERDING Office Manager 651-488-9884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2020-08-22 |