| NPI | 1548375116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP L. BANGLE Dentist 262-542-1662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 2318) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2020-08-22 |