| NPI | 1023237559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS GERARD BRADLEY Owner 920-261-3560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 5275-015) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-08-22 |