| NPI | 1508201997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA L ANDERSLAND Owner/Dentist 612-384-0527 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D12655) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D13123) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2013-04-30 |