| NPI | 1780601336 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RALPH A PAMENTER President 262-786-4119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WI 5000813G) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2020-08-22 |