| NPI | 1023073178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA L LYSLOFF Office Administrator 608-222-8344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5133) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1727G) |
| 1223G0001X Dentist, General Practice (Licence: WI 2808) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2020-08-22 |