| NPI | 1417447210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANIEL COGSWELL Owner 651-888-4680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: MN D13398) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2024-08-14 |