| NPI | 1528771508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HELEN TOME Executive Director 218-365-5678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 251V00000X Voluntary or Charitable |
| Enumeration Date | 2023-01-04 |
| Last Update Date | 2023-01-05 |