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 |