| NPI | 1992822290 |
|---|---|
| Other Name | SOUTHSIDE DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | WILLIAM HENRY TENDLE Executive Director 612-821-2800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2014-04-30 |