| NPI | 1912058058 |
|---|---|
| Other Name | EAST SIDE FAMILY DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | REUBEN MOORE CEO 651-602-7500 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN 302133) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2024-05-15 |