| NPI | 1801959788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY R. PETERSEN President 701-772-7379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2014-05-14 |