| NPI | 1649492208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY V KATT Manager 262-338-2992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 2788) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 2487) |
| 1223P0300X Dentist, Periodontics (Licence: WI 2608) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |