| NPI | 1598105637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GONZALO E HERNANDEZ President 920-739-6808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 4564-015) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2023-03-07 |