| NPI | 1841404704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL ANTHONY WALSH Officer 262-658-1410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WI 5001276015) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-08-22 |