| NPI | 1679911531 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMEE ROSELL Executive Director 612-377-6108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 125J00000X Dental Therapist (Licence: MN DT3) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: MN D9933) |
| 1223D0001X Dentist, Dental Public Health (Licence: MN D9919) | |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2013-06-12 |