| NPI | 1518910504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT ERIC STAMP Owner 320-252-3330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN 9235) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D11508) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2020-08-22 |