| NPI | 1225112022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL ALLEN HURSY Managing Member 651-257-4471 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 8021) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2020-08-22 |