| NPI | 1306908371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT J MARTIN Endodontist Oral And Maxillofacial 262-241-3019 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WI 2529) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 2529) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2012-04-24 |