| NPI | 1902099559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT A NUSTAD VP, Treasurer 651-388-1515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2007-08-27 |