| NPI | 1669640108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANN KIELLEY CORBETT Office Manager 608-251-8790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 4304) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 5169) |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2008-02-19 |