| NPI | 1225196363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID JEROME HAGSTROM Owner 507-288-1744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D11449) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2020-08-22 |