| NPI | 1184829509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE CAMARA GOOD Periosontist 612-724-1717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN d11889) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MN d11718) |
| 1223P0700X Dentist, Prosthodontics (Licence: MN d12007) | |
| Enumeration Date | 2007-06-16 |
| Last Update Date | 2020-08-22 |