| NPI | 1871638254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN WILLIAM IWEN President 920-845-2225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 4930 and 4892) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2009-04-15 |