| NPI | 1659749778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSS OBERSCHLAKE Dentist 920-850-3031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WI 7251-15) |
| Enumeration Date | 2015-09-05 |
| Last Update Date | 2015-09-05 |