| NPI | 1861525289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN K DUDLEY Office Manager 920-739-1214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2020-08-22 |