| NPI | 1225127947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON ROBERT HENDERSON Owner 920-725-5357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5223-015) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2023-06-16 |