| NPI | 1538112180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOLEEN KAY HALL Business Manager 952-934-3383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 7951) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN 10519) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2020-08-22 |