| NPI | 1205204674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER JORGENSON Dentist 320-235-2010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN 9800) |
| Additional Taxonomies | 125J00000X Dental Therapist (Licence: MN DT54) |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2015-09-02 |