| NPI | 1790027134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY MOTT President And CEO 763-227-5222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 1375) |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2013-03-25 |