| NPI | 1891829669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI KUBALL Admin & Financial Coordinator 507-281-3121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2021-05-27 |