| NPI | 1720206428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBI A KECKHAFER Practice Manager 952-841-9658 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2015-06-25 |