| NPI | 1841991262 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW SODERHOLM Owner/Doctor 320-298-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2023-03-13 |
| Last Update Date | 2023-03-13 |