| NPI | 1780998997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS C KELLEY Periodontist 262-787-9075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WI 5257015) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2010-07-29 |