| NPI | 1760592406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS JOHN HICKEY Owner 763-441-4200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 8940) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-08-22 |