| NPI | 1871668830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETE VANG Vice President 651-222-6738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MN 11210) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2007-08-02 |