| NPI | 1851466155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT CURTIS FREDRICKSON President Owner 651-488-5888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D11125) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2020-08-22 |