| NPI | 1174884753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL NICHOLAS FRYS President 952-831-1332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MN 8040) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2012-05-31 |