| NPI | 1275753659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY J KOLL President 920-832-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: WI 4243) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2020-08-22 |