| NPI | 1366026676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK H HANSON Doctor/Owner 920-884-2808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-05-12 |
| Last Update Date | 2021-05-14 |