| NPI | 1346462355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY K WICHMANN Owner 952-224-8090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D12069) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |