| NPI | 1801938030 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN LANE BAKKE Employee Dentist 605-665-7476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SD m996) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2020-08-22 |