| NPI | 1134490758 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS JAY AUGUSTIAN Chief Executive Officer 920-405-5382 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2022-04-13 |