| NPI | 1013662246 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRETCHEN WELLNER Director Of Operations 262-522-7447 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-02-16 |
| Last Update Date | 2022-02-16 |