| NPI | 1942219852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL L MENGEDOTH CEO 218-236-7076 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D11185) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2013-12-03 |