| NPI | 1306924584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL H GLENN President 651-322-5788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN D10462) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2020-08-22 |