NPI | 1194066167 |
---|---|
Entity Type | Organization |
Authorized Contact | BLANE R CHRISTMAN Owner 715-726-1060 |
Organization Subpart ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: WI 4080) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: WI 6466) |
Enumeration Date | 2013-03-15 |
Last Update Date | 2013-03-15 |