| NPI | 1154989507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATRINA ANDRADA LEANO Dentist/Owner 651-226-1029 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2019-05-31 |