| NPI | 1447869789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT HEIL President 920-428-5416 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2022-01-07 |