| NPI | 1083929814 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNETTE MARIE LAUR Office Manager 414-282-5560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5258-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 5001352-12) |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2010-08-17 |