| NPI | 1215083183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA J KENT Office Manager 763-557-0911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 10011) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2020-08-22 |