| NPI | 1073828604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN CLAYTON KITTLESON Vice President 262-241-3141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 4648-015) |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2010-08-06 |