| NPI | 1740336114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY GROTE Owner 920-887-8423 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 2582-015) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2020-08-22 |