| NPI | 1720129190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN DOYLE KELLY Pres 920-907-1400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 4211) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2012-01-25 |