| NPI | 1780062349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL S BUBON Owner 262-522-7447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 4015-15) |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2015-05-14 |