| NPI | 1932467222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP DOUGLAS Practice Owner 715-855-1020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6330-015) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2012-04-25 |