| NPI | 1528421278 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS ELLIS HOOVER Periodontist 952-920-9209 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: MN D11710) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2016-03-31 |