| NPI | 1669635066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH DAVID DEGUZMAN Owner 262-250-7787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WI 4076) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2008-07-07 |