| NPI | 1528241486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRENCE JOHN RIESCH President 262-253-6588 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 4287) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 4287) |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2008-06-06 |