| NPI | 1134340938 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRK RICHARD FISHBAUGH President 920-434-1515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 4714-015) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2020-08-22 |