| NPI | 1316315351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUPRIYA SHETTY Owner 262-691-4555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2015-09-08 |