| NPI | 1992818751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTA SUSAN BAUER Dentist 763-323-0678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 9624) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN 11195) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2015-04-22 |