| NPI | 1649597204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY L WILLIAMS President 763-559-4778 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MN D9629) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MN 9675) |
| 1223G0001X Dentist General Practice (Licence: MN 9629) | |
| Enumeration Date | 2010-04-22 |
| Last Update Date | 2010-04-22 |