| NPI | 1598040263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENITA C BURRELL Periodontist 262-384-0092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WI 6086-15) |
| Enumeration Date | 2011-10-13 |
| Last Update Date | 2011-10-13 |