| NPI | 1265730287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY EDWARD COOPER President 920-452-1110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: WI 6314-015) |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2011-03-01 |