| NPI | 1881364958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANAEL D BENASSI Member 608-535-9382 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2022-04-28 |