| NPI | 1063951663 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY L MACKMAN Owner Director 414-476-9400 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2023-08-28 |