| NPI | 1790712180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS J. LASELLE Owner/ President 920-733-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 3124-015) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 5291-015) |
| 1223G0001X Dentist, General Practice (Licence: WI 4766-015) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2020-08-22 |