| NPI | 1255343828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY JH HOLSEN President 920-459-8467 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5001664) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2020-08-22 |