| NPI | 1588764435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KURTIS STANLEY KELLNER President 920-457-5170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 0002949) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2009-07-07 |