| NPI | 1083891261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA R LEE Office Manager 262-654-6770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 5188015) |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2009-10-05 |