| NPI | 1508316753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIAN "TRACIE" CLUBB Assistant Manager 262-223-0280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: WI 5279) |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2016-11-16 |