| NPI | 1801260187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WHITNEY CHRISTINE HUSTAD DAVIDSON Owner 218-606-1040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D12242) |
| Enumeration Date | 2015-11-24 |
| Last Update Date | 2015-11-24 |