| NPI | 1538434154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENEVIEVE POPPE Director Of Operations 608-358-3370 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 7275-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 3838-15) |
| Enumeration Date | 2012-03-14 |
| Last Update Date | 2014-06-24 |