| NPI | 1659670362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUG S WOLFF Owner 651-439-2600 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D111236) |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2011-03-21 |