| NPI | 1396978136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY RICHARD PETERSEN President 701-772-7379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2009-08-27 |