| NPI | 1588294110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW ROBERT BEZEK Owner 320-252-1085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2021-06-14 |