| NPI | 1184775892 |
|---|---|
| Doing Business As | EASTRIDGE DENTAL |
| Entity Type | Organization |
| Authorized Contact | JOHN E. PATRICKUS President 920-468-8144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2008-07-01 |