| NPI | 1316976517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOAN A SHEPPARD Owner Officer 952-890-5450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D8868) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D7323) |
| 122300000X Dentist (Licence: MN D11218) | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2020-08-22 |