| NPI | 1790182822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW T WISWALL President 605-789-2017 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: SD D0827) |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2014-12-04 |