| NPI | 1831857788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARA THAO Office Manager 651-735-4661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2021-12-07 |