| NPI | 1427572932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID ANDREW BATES President 651-338-6102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN D12749) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2017-07-27 |