| NPI | 1477871457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY KENT BRUNSOMAN President 651-774-9611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN D6950) |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2011-04-21 |