| NPI | 1477848828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI CARLSON Receptionist 701-775-0682 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ND 1535) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2011-06-14 |