| NPI | 1891979050 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOAN M NELSON Clinical Manager 651-451-9101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 3142423) |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2008-08-13 |