| NPI | 1689899197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY URLAKIS Periodontist 608-754-6852 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WI 5000576-015) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2020-08-22 |