| NPI | 1922361526 | 
|---|---|
| Doing Business As | TWIN CITIES MODERN DENTISTRY | 
| Entity Type | Organization | 
| Authorized Contact | MICHAEL RYAN HENRICKSON Dentist 651-777-8900  | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN 11920)  | 
| Enumeration Date | 2012-06-19 | 
| Last Update Date | 2012-07-13 |