| NPI | 1619481561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVONNE NADELHOFFER-CULLEN Owner 414-241-8175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: OR D8897) |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2017-11-29 |