| NPI | 1619780582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEREDITH BURNS Owner 952-297-2287 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2025-01-27 |
| Last Update Date | 2025-01-27 |