| NPI | 1558361667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY JOHN MATTSON Owner 218-829-4243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN MOEN 9531) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN Mattson 10813) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2020-08-22 |