| NPI | 1780198010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADENA FERN BORODKIN Pediatric Dentist 763-222-1299 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN D11961) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN D11564) |
| Enumeration Date | 2017-11-22 |
| Last Update Date | 2017-11-22 |