| NPI | 1407208002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER POTRYKUS Owner 262-646-2771 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6886) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2016-07-07 |