| NPI | 1174543649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT FLESNER Vice President 262-377-2847 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: WI 3728) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2020-08-22 |