| NPI | 1093868358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY OLSON Campus Administrator 715-833-6675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| 1223P0221X Dentist Pediatric Dentistry | |
| 1223D0001X Dentist Dental Public Health | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2013-04-19 |