| NPI | 1609272822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY AMANDA JONES Pediatric Dentist, Owner 608-206-1233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN d13120) |
| 1223P0221X Dentist, Pediatric Dentistry | |
| Enumeration Date | 2014-11-16 |
| Last Update Date | 2020-12-08 |