| NPI | 1003908856 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRSTEN M. DAVIES Owner 262-547-5813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 4907-015) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 5000400-015) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2011-07-05 |