| NPI | 1619064557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY MADISON Dentist 218-722-7831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D10521) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D11583) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-08-22 |