| NPI | 1699901140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE A CHAVEZ Owner 952-465-0105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: MN D11399) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2014-06-23 |