| NPI | 1366614885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAN K STREICH Clinic Administrator 608-661-6412 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 3628) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6136) |
| 122300000X Dentist (Licence: WI 6215) | |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2008-08-27 |