| NPI | 1285649921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD HENRY NELLEN President 414-281-3344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WI 2699) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2020-08-22 |