| NPI | 1790840734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYSETTE L BRUEGGEMAN Owner 262-334-3084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 4368) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: WI 4408) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2020-08-22 |