| NPI | 1841539491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONETTA BAKKE Dentist 218-751-8325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MN D12524) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MN D8207) |
| Enumeration Date | 2013-02-01 |
| Last Update Date | 2013-02-01 |