| NPI | 1780721654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAND ALLEN LEE President 262-694-6055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 3260) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2020-08-22 |