| NPI | 1558746271 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANELLE ESTRADA Practice COO Rdinator 701-774-3333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 2170) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN 1726) |
| 124Q00000X Dental Hygienist (Licence: ND 1543) | |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2015-07-23 |