| NPI | 1114029048 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE E HOLMSTROM Owner 414-964-8850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5002167-015) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2020-08-22 |