| NPI | 1639568603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH CHARLES CLARK Endodontist 920-246-6118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WI 3707-15) |
| Enumeration Date | 2015-01-14 |
| Last Update Date | 2015-01-14 |