| NPI | 1538963590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASANDRA JOHNSON General Manager 763-515-4000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2025-04-01 |
| Last Update Date | 2025-04-01 |