| NPI | 1790822690 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA J BUCK Treatment Coordinator 651-437-9812 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 8822) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2020-08-22 |