| NPI | 1811327190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLINTON LAWRENCE ROBERTS Owner Dentist 218-454-0523 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: MN D10518) |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2013-11-22 |