| NPI | 1952707390 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANELLE ANN FERBER-STUMPF Owner 262-970-0111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 3207-015) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2014-11-12 |