| NPI | 1164959938 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID S GESKO Senior VP/Dental Direction 9528-863-7577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN 11643) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MN 11843) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MN 12166) | |
| 1223P0300X Dentist, Periodontics (Licence: MN 10651) | |
| 1223P0700X Dentist, Prosthodontics (Licence: MN 12628) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN 12105) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN 12245) | |
| 125Q00000X Oral Medicine (Licence: MN 13340) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |