| NPI | 1649079039 |
|---|---|
| Former Legal Business Name | BLOOMINGTON FAMILY DENTAL, PLLC |
| Entity Type | Organization |
| Authorized Contact | BRIAN M GRAY Owner/Dentist 952-856-0089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2025-03-10 |
| Last Update Date | 2025-03-10 |