| NPI | 1730397233 |
|---|---|
| Former Legal Business Name | PARK-WEST PEDIATRIC DENTAL ASSOCIATES |
| Entity Type | Organization |
| Authorized Contact | ERIC JAMES VAN MILLER Owner Dentist 920-592-8940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 5182-015) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2024-02-22 |