| NPI | 1285141481 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDRA KAY BODA President/Owner 715-552-8165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WI 6901-15) |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2018-01-09 |