| NPI | 1447658950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEIDI NICHOLS-JOHNSON Owner 701-751-7510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ND 1963) |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2014-12-16 |