| NPI | 1780133983 |
|---|---|
| Doing Business As | WELLSTONE DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | SAHRA NOOR CEO 612-332-4973 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2016-09-28 |