| NPI | 1720172992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN A KIMMEL President 262-241-0900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 4130-015) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2025-07-30 |