| NPI | 1932200037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRIS DAVID JOHNSON President 763-772-0330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MN D10585) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-08-22 |