| NPI | 1972873156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOM G ANDERSON Owner Dentist 218-236-7076 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN MN 9657) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: MN D12404) |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2012-01-05 |