| NPI | 1710160486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE WILLOUGHBY President 262-658-3559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 4998015) |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2022-06-02 |