| NPI | 1366568206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE HARTMANN Clinic Manager 651-905-4834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2020-07-06 |