| NPI | 1316142714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANN C LASKY Administrator 715-421-1515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 3432) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 2958) |
| 1223G0001X Dentist, General Practice (Licence: WI 1070G) | |
| 1223G0001X Dentist, General Practice (Licence: WI 4111) | |
| 1223G0001X Dentist, General Practice (Licence: WI 1389) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2020-08-22 |