| NPI | 1689018848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL LLOYD HANNEMAN Owner 920-233-6001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 2950) |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2013-04-18 |