| NPI | 1851815310 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB LEE BARTHOLD President 763-746-6567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN D13073) |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2017-07-26 |