| NPI | 1871750026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY VASSEUR Office Manager 612-782-7000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D12142) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D12034) |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2008-05-16 |