| NPI | 1841333564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES L EVANS President 262-547-2827 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 0379G) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2020-08-22 |