| NPI | 1093113789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSIE LYNN ERICKSON Office Manager 715-262-3382 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6932) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 3523) |
| Enumeration Date | 2014-12-11 |
| Last Update Date | 2018-03-08 |