| NPI | 1154480002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARC JACOBSON Vice President 262-241-2060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 2475-015) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2020-08-22 |