| NPI | 1528195377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAN M WAITE General Dentist 608-348-3031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 4104) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2020-08-22 |