| NPI | 1336584846 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE JOHNSON Dentist 920-471-9890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 08964) |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2013-05-10 |