| NPI | 1992964530 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLY J DONABAUER President 218-233-1754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MN 11563) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2008-06-09 |