| NPI | 1730339367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP ANDREW BAKER President 920-233-1030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WI 4436-015) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2008-09-18 |