| NPI | 1073904470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICK WEISS Dentist/Owner 262-227-1348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IN 12011545A) |
| Enumeration Date | 2015-02-07 |
| Last Update Date | 2015-02-07 |