| NPI | 1689743619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA L ELLERMAN Administrative Assistant 920-684-7103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 0004608) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2020-08-22 |