| NPI | 1154781870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISSA EDWARDS Dentist 920-731-2211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6542-15) |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2016-02-24 |