| NPI | 1235247834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY STEPHEN NOVAK President 262-547-8665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2012-08-21 |