| NPI | 1053439851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW MARK OLSON Business Assistant 715-832-3832 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5001478) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2020-08-22 |