| NPI | 1235593609 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY ROBERT BULLION Owner 414-273-5553 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 4389-15) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2016-04-11 |