NPI | 1821753864 |
---|---|
Entity Type | Organization |
Authorized Contact | CHAD HENDRICKS Credentialing 612-859-0444 |
Organization Subpart ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
Enumeration Date | 2021-11-04 |
Last Update Date | 2021-11-04 |