| NPI | 1760686984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL ROBERT MILLIREN Owner 651-437-7844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 9846) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN 12424) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2020-08-22 |