| NPI | 1396856100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL THOMAS PETERSON President Of Corp 320-252-2454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| 126800000X Dental Assistant | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2014-06-17 |