| NPI | 1417007436 |
|---|---|
| Doing Business As | WEST SIDE DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | REUBEN MOORE CEO 651-602-7500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN 302133) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2024-05-15 |