| NPI | 1649673096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON HEEZEN Owner, Dentist 888-825-4214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D13103) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2014-09-30 |