| NPI | 1184793580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED A LACOURT Dentist 414-258-2117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 3547WI) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2015-06-22 |