| NPI | 1891948329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRECIA T. JACOBSON CEO 218-262-3730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D10897) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2008-10-28 |