| NPI | 1609289073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN MCDONALD BRENNER Dentist 563-271-9529 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA DE60291757) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2014-06-03 |