| NPI | 1366629560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY DONALD BONGARD President 612-729-3244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN 8412) |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2008-01-30 |