| NPI | 1154971380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT L BODIN President 952-881-8404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2019-10-24 |