| NPI | 1477639102 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL A KOLLATH President 920-339-8980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 1857-G) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2020-08-22 |