| NPI | 1205285699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IAN HEDGES Executive Director 608-314-1921 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2022-10-11 |