| NPI | 1235466988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUY K. JENSEN Oral Surgeon 920-923-0111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 5001856-15) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 5000111-15) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 2787-15) | |
| Enumeration Date | 2009-11-17 |
| Last Update Date | 2009-11-17 |