| NPI | 1154477818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH M BERO Dds Dentist 262-338-8704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI WI2517K) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI WI5624) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2009-07-06 |