| NPI | 1891174967 |
|---|---|
| Other Name | EAST TOWNE DENTAL ASSOCIATES |
| Entity Type | Organization |
| Authorized Contact | VALI KIAIE Doctor/Owner 262-285-3408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WI 1001078-15) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2015-05-22 |