NPI | 1558746271 |
---|---|
Entity Type | Organization |
Authorized Contact | DANELLE ESTRADA Practice Coordinator 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 |