| NPI | 1275973166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED FRISBIE-TEEL Owner/Doctor 262-327-6100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WI 6841.15) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WI 6591) |
| 1223P0300X Dentist, Periodontics (Licence: WI 6852.15) | |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2013-06-25 |