| NPI | 1457998106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED ANTHONY LACOURT Chief Dental Officer 414-303-7484 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2019-12-02 |