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 |