| NPI | 1669671152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN ALLEN SELCHOW Owner 651-287-3080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D9967) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2007-07-13 |