| NPI | 1992117501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY ALWORTH ANDERSON President 612-619-0917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ND 2214) |
| Enumeration Date | 2014-05-30 |
| Last Update Date | 2014-05-30 |