| NPI | 1902973019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK STEVEN MANDEL President 414-355-3551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5000797) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2020-08-22 |