NPI | 1467877001 |
---|---|
Entity Type | Organization |
Authorized Contact | MARY RECK Dental Assistant 651-738-2125 |
Organization Subpart ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MN 11707) |
Additional Taxonomies | 122300000X Dentist (Licence: MN 13264) |
Enumeration Date | 2014-02-19 |
Last Update Date | 2014-02-19 |