| NPI | 1962533588 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | N. GENE PITTMAN Owner 262-251-6070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223P0700X Dentist, Prosthodontics | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2020-08-22 |