| NPI | 1174992937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS MAURY Owner 920-921-6260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 5369015) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: WI 5369015) |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2015-10-07 |