| NPI | 1689811853 |
|---|---|
| Doing Business As | PARK AVENUE DENTAL |
| Entity Type | Organization |
| Authorized Contact | JEFFREY MICHAEL CLARK Dentist 715-723-0367 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6137015) |
| Enumeration Date | 2009-01-09 |
| Last Update Date | 2009-01-09 |