| NPI | 1952546061 |
|---|---|
| Doing Business As | DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | MARY JOHNSON Chief Operating Officer 612-884-0802 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2008-12-04 |
| Last Update Date | 2013-06-05 |