| NPI | 1609930627 |
|---|---|
| Doing Business As | AVENUE DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | BRIAN ANTHONY STARK President 262-251-6555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2020-08-22 |