| NPI | 1215730627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLAS BRANSHAW Owner 262-200-9445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2025-03-31 |
| Last Update Date | 2025-08-12 |