| NPI | 1962531178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID PAUL LUDINGTON Owner 608-782-8193 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2013-05-29 |