| NPI | 1518132117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT DAVID LACOSSE CEO 218-728-4272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D10551) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2008-04-24 |