| NPI | 1356414114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN BERTON LUTHER President 920-734-9148 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WI 5588-015) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-08-22 |