| NPI | 1538189089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL J BOURESSA President 920-725-3033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5002124-015) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2020-08-22 |