| NPI | 1659793115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON M COEN Owner/President 651-398-9686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: AZ D7588) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2014-01-16 |