| NPI | 1245646082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON J BUSHONG Owner 715-573-3868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6524-15) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2024-11-12 |