| NPI | 1326402470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHASE A PRUITT Owner 507-316-2205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 28850) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2016-04-05 |