| NPI | 1235311614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VACHAREE S PETERSON CEO 651-925-8400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 460668000) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2014-06-24 |