| NPI | 1437285566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOREN CHARLES SWANSON President 920-231-8120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5001301015) |
| Enumeration Date | 2007-02-25 |
| Last Update Date | 2020-08-22 |