| NPI | 1871663831 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS MARK HANSON Owner 763-682-9796 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 10610) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN 11192) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2008-10-08 |