| NPI | 1518317858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA VILLAGRAN Office Manager 414-355-5020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5496) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 100132615) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2016-06-17 |