| NPI | 1770213639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAUREEN DERDIE O'SULLIVAN Advanced Dental Therapist 612-801-5203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2022-06-14 |