| NPI | 1528163169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID ROBERT LASTE President 414-259-0665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5001793-015) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2020-08-22 |