| NPI | 1780086108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN M MOORE President 920-996-0123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5725) |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2014-09-17 |