| NPI | 1235212887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS M O'BRIEN President 262-544-4404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5057) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1317G) |
| 1223G0001X Dentist, General Practice (Licence: WI 4606) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2020-08-22 |