| NPI | 1083829881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRYL STICH President 262-786-8440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5416-015) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 2339) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-08-22 |