| NPI | 1417340563 |
|---|---|
| Doing Business As | 36TH STREET DENTAL |
| Entity Type | Organization |
| Authorized Contact | RYAN MICHAEL DUNLAVEY President 612-799-7525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2015-03-13 |
| Last Update Date | 2015-03-13 |