| NPI | 1912078700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY J STEWART Office Administrator 507-451-2600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN 8498) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN 10720) |
| 122300000X Dentist (Licence: MN 11401) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2020-08-22 |