| NPI | 1578832853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON D. JOHNSON Chief Manager/Periodontist 715-832-5396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: WI 6810-015) |
| Enumeration Date | 2011-12-15 |
| Last Update Date | 2011-12-15 |