| NPI | 1972650745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE M C BOLTERMAN Owner President 763-421-4640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN d11438) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2020-08-22 |