| NPI | 1194791384 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT W. GLINEBURG President 651-646-9474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN 8257) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2020-08-22 |