| NPI | 1144241340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLS LAWRENCE NELSON President 262-662-3066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 3326) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2020-08-22 |