| NPI | 1932269875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES PAUL GARRISON Manager 920-563-9373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5000615015) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2024-06-07 |