| NPI | 1477587459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS LEE CARLSON Owner President 218-741-0089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D7791) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2020-08-22 |