| NPI | 1376762476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLEMENS KENNETH STOECKL Owner 262-532-0022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5001195-015) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2020-08-22 |