| NPI | 1407257108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE FISHER Owner 262-241-0400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 5127-015) |
| Enumeration Date | 2014-09-12 |
| Last Update Date | 2014-09-12 |