| NPI | 1912013640 |
|---|---|
| Former Legal Business Name | BROAD STREET FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER KELLY MEEHAN Dds/Owner 507-345-4259 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 10009) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN 12148) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2016-05-03 |