| NPI | 1851784599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL RICHARD KOESTER Owner/Manager 414-762-9010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WI 2481-15) |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2015-03-05 |