| NPI | 1922477793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN MATHYS Dentist 507-250-0701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6410-15) |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2015-09-22 |