| NPI | 1164894606 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANURADHA GANTA Owner 763-222-8485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS037562) |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2015-10-23 |