| NPI | 1639486285 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARI L JOHNSON Office Manager 507-376-5525 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IA 07092) |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2010-09-02 |