| NPI | 1306236708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILY SCHMALZ KELLY Periodontitist 651-261-3644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MN D12773) |
| Enumeration Date | 2015-01-23 |
| Last Update Date | 2016-01-08 |