| NPI | 1609944644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE THIES Business Manager 608-257-0116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 5551) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 2469) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2021-08-16 |