| NPI | 1235291816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYCLARE JENSEN Office Manager 218-262-5536 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 7167) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-08-22 |