| NPI | 1902131055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM STEWARD Provider Service Manager 866-273-8204 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6365015) |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2009-10-07 |