| NPI | 1912037896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM CARLTON MAUTHE Dentist President 920-921-1244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5479) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2020-08-22 |