| NPI | 1679758262 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY THOMAS KEESLER President 920-729-0889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WI WI 4174-015) |
| Enumeration Date | 2008-01-02 |
| Last Update Date | 2008-01-02 |