| NPI | 1689635203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY A WILSON Office Manager 262-637-7276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5000934) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2020-08-22 |