| NPI | 1649294257 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT JAMES ANTISDEL President / Dentist 1262-284-7111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WI 2485-015 / 2486-015) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-08-22 |