| NPI | 1336560275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK JOHN VENEMAN President 651-770-7175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 10146) |
| Enumeration Date | 2013-12-19 |
| Last Update Date | 2013-12-19 |