| NPI | 1457472797 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY A. EBY Dentist/Owner 920-563-2928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WI 5909-015) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2008-09-02 |