| NPI | 1841317732 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK IVAN MALTERUD Owner 651-699-2822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 9454) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2020-08-22 |