| NPI | 1154743177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN OSTEEN Executive Director 920-887-1766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: WI 27426020) |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2014-01-10 |