| NPI | 1437320512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATALIE ANN PETERSON Owner 262-271-8803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WI 5600-015) |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2015-03-26 |