| NPI | 1649497025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIRLEY MARIE FERRENS Office Manager 952-841-0122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 3153983) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2020-08-22 |