| NPI | 1447416607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN MARIE MILLER Administrator 612-374-4321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI D10995) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN M11654) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2008-08-06 |