| NPI | 1861340465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER PREBLE Financial Coordinator 262-694-5272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2026-03-19 |
| Last Update Date | 2026-03-19 |