| NPI | 1578313201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIELLE RENZ Owner 701-258-3308 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2024-03-25 |