| NPI | 1003140070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVE KRAUSE Treasurer 800-487-4867 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6155) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2012-03-19 |