| NPI | 1497113674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE MINER Owner 952-472-7717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D11974) |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2016-02-03 |