| NPI | 1063634228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM ROBERT RENNER Owner 262-549-3640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WI 5002149-015) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |