| NPI | 1275707580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND A HELLICKSON Dentist/Owner 612-789-3573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D6670) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D7910) |
| 1223G0001X Dentist, General Practice (Licence: MN D7712) | |
| 1223G0001X Dentist, General Practice (Licence: MN D11408) | |
| 1223P0300X Dentist, Periodontics (Licence: MN D10650) | |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2008-04-17 |