| NPI | 1659829810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL GEORGE CULVER Owner 262-782-1655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WI 2961-15) |
| Enumeration Date | 2016-09-16 |
| Last Update Date | 2016-09-16 |