| NPI | 1972894061 |
|---|---|
| Doing Business As | PLYMOUTH STATION DENTAL |
| Entity Type | Organization |
| Authorized Contact | CARL BENTON FITZSIMMONS President/CEO 763-577-9840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN D11044) |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2011-04-25 |