| NPI | 1306051230 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL BRENGMAN Owner President 651-905-9090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: MN 9954) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2017-03-22 |