| NPI | 1235665464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA HEINEMEYER Administrative Assistant 920-733-4787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5001068G) |
| Enumeration Date | 2017-05-09 |
| Last Update Date | 2017-05-09 |