| NPI | 1508926841 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY VINCENT OTOOLE President 952-476-0070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MN 9011) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MN 11543) |
| Enumeration Date | 2006-12-09 |
| Last Update Date | 2020-08-22 |