| NPI | 1962631952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA ANN BEAUPRE Registered Dental Hygienist 920-242-2209 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: WI 6637-016) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2009-07-10 |