| NPI | 1386189801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN CHARLES FINCHAM Executive Director 612-961-0866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 251V00000X Voluntary or Charitable |
| Enumeration Date | 2016-12-20 |
| Last Update Date | 2017-11-15 |