| NPI | 1871656587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIPTON J BROWN President 920-725-0400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WI 4849-015) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WI 4833-015) |
| 1223G0001X Dentist General Practice (Licence: WI 5000606-015) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2020-08-22 |