| NPI | 1154909414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA STROHBUSCH Operations Manager 920-285-7441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2021-04-05 |