| NPI | 1356489603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALI KIAIE President 262-241-8880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 5993) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 5301) |
| 122300000X Dentist (Licence: WI 5304) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2020-08-22 |