| NPI | 1548797590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN O'DELL Member 605-641-3586 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SD D1018) |
| Enumeration Date | 2017-05-20 |
| Last Update Date | 2017-05-20 |