| NPI | 1336804178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRASANNA KUMARI V MUDDANA Co Owner/Operations Manager 262-563-9100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2021-11-06 |
| Last Update Date | 2021-11-09 |