| NPI | 1326173279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN DANIEL MOLLDREM Owner 952-974-5116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 11329) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2020-08-22 |