| NPI | 1669691515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY MCCULLY Administrator 608-238-7112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2013-10-03 |