| NPI | 1295187094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE MARGARET FALBO Dentist 651-470-7304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NE 7328) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2016-07-06 |