| NPI | 1982262721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL DULAC Dentist 612-251-7543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2019-06-05 |