| NPI | 1184959405 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN JOSEPH FARROW Member 608-204-0222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WI 5964-015) |
| Enumeration Date | 2009-10-04 |
| Last Update Date | 2009-10-04 |