| NPI | 1285029652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW SANDBERG Owner 414-258-8190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI WI 6664-15) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2015-04-02 |