| NPI | 1174129019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARREN THOMAS MARABELLI Chief Operating Officer 608-609-4023 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0300X Dentist, Periodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2020-12-07 |