| NPI | 1497956304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK C BERDAHL President 605-332-4751 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SD M911) |
| Additional Taxonomies | 122300000X Dentist (Licence: SD M687) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2020-08-22 |