| NPI | 1134339500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON WILLIAM COOKE President 920-733-7770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WI 5864-015) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-08-22 |