| NPI | 1821451774 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN MICHAEL EDLUND Chief Manager 651-645-0449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D12097) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2016-03-29 |