| NPI | 1801462395 |
|---|---|
| Doing Business As | MYDENTAL 13TH AVE |
| Entity Type | Organization |
| Authorized Contact | HEIDI LUND Operations Leader 701-532-2500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2021-06-03 |