| NPI | 1295890895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID DOUGLAS VANDEVELDE President 651-457-6231 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D8801) |
| Enumeration Date | 2006-12-25 |
| Last Update Date | 2020-08-22 |