| NPI | 1174600621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JOHN GITZEN President Owner Doctor 952-920-9579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2012-01-12 |