| NPI | 1750610721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE FAYE WEBB Receptionist 218-751-4523 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 8362) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN 10118) |
| Enumeration Date | 2009-12-21 |
| Last Update Date | 2009-12-21 |