| NPI | 1679866701 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESS T THOMAS Orthodontist 262-251-6820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 6375-015) |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2015-12-22 |