| NPI | 1568591139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY DAVID LISKA Principal 763-546-2209 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MN 9376) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2020-08-22 |