| NPI | 1548795206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER STOCK Insurance Specialist 920-857-1966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019029593) |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2017-05-01 |