| NPI | 1386783488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER ALLEN BLAKE Dentist President Of Service Corpor 262-789-9200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 5002097015) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2010-10-27 |