| NPI | 1326242678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYSSA A HEDSTROM Owner 218-387-2774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D11942) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2008-05-01 |