| NPI | 1750774428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDGAR FERNANDO MANTILLA CEO 612-724-1717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN D11889) |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2015-03-05 |