| NPI | 1295185981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERTO MONTEAGUDO Clinical Director/Provider 414-383-5833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 4186) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2016-06-14 |