| NPI | 1851422596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY L LARSON Crst Dental Administrative Manager 605-964-0736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2022-08-05 |