| NPI | 1578606067 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREEN MARIE BALLINGER Dentist 651-204-9353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D11303) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2009-10-28 |