| NPI | 1295015444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG B JANSSEN Owner 920-983-8383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 3485) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2011-09-13 |