| NPI | 1891100772 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA JILL GRABOUSKI Dentist 712-253-5703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MN D13437) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2014-06-30 |