| NPI | 1336590959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARLENE GUASTEFERRO Managing Physician 800-397-6347 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1001042) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2016-06-24 |