| NPI | 1063512267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ORVIS JOHNSON Dentist 920-923-0310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: WI 5000785-015) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-08-22 |