| NPI | 1609908219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES EBNER LUETZOW President 262-554-5468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 2387) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2020-08-22 |