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Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Dental |
261QD0000X |
| NPI Number | 1699922849 |
| LBN Legal business name | MORTENSON FAMILY DENTAL CENTER |
| Authorized official | STEVE JAMES - (COO) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 08/19/2008 |
| Last updated | 08/19/2008 - About 18 years ago |
| Identifiers | n/a |
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MORTENSON FAMILY DENTAL CENTER
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MORTENSON FAMILY DENTAL CENTER