| NPI | 1215450531 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA A GUTTORMSEN General Denist/Officer 262-945-7970 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: 6307-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: 6307-15) |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2022-07-21 |