| NPI | 1194944991 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN FRAZIER President 920-432-0634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 2345-015) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-08-22 |