| NPI | 1639574585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE MORSEHEAD Patient Experience Coordinator 262-484-4356 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2014-11-04 |