| NPI | 1295268019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANAE W JOHNSON Manager 715-496-1128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 1001483) |
| Enumeration Date | 2017-04-08 |
| Last Update Date | 2017-04-08 |