| NPI | 1770672958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY LEE JOHNSON President 507-376-5525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: MN 10185) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2023-03-07 |