| NPI | 1225307267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYRIL JOSEPH VAN SISTINE Partner / Manager 920-336-2500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5001499) |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2011-12-20 |