| NPI | 1437236536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW THOMAS PRUHS Owner/Partner 262-251-5355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5334015) |
| Additional Taxonomies | 122300000X Dentist |
| 1223G0001X Dentist, General Practice (Licence: WI 0004063) | |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-03-11 |