| NPI | 1750996641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY WEGNER Operations Support Manager 715-598-7473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2020-09-09 |