| NPI | 1669909370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE GRUENEBERG Chief Administrative Officer 414-778-5274 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2017-05-12 |