| NPI | 1649318619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD CARLYLE AXEL President 952-937-2839 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 7654) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2020-08-22 |