| NPI | 1497842801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN T WISWALL President 605-373-0245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SD M446) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2020-08-22 |