| NPI | 1922181197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN M. LARSON Clinic Administrator 763-420-4421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D11341) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN 9790) |
| 1223G0001X Dentist, General Practice (Licence: MN 10067) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2020-08-22 |