| NPI | 1386715704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANA ELIZABETH MCVEIGH HEISLER President 763-428-2217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D9395) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2019-07-02 |