| NPI | 1861804650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALLY E OWENS Owner/Officer/Member 715-341-5441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6829-15) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2014-05-28 |