| NPI | 1144764978 |
|---|---|
| Former Legal Business Name | SUMMIT SQUARE DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | TIMOTHY J MATHISON President & CEO 608-709-8303 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2016-12-13 |