| NPI | 1255573184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA JACQUINOT Business Manager 608-852-7298 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WI 6103) |
| Enumeration Date | 2009-03-24 |
| Last Update Date | 2009-03-24 |