| NPI | 1255888103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY JEANNINE SMALKOSKI Dentist 262-554-9055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 268160) |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2016-09-08 |