| NPI | 1962916650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA GUTIERREZ Smile Club Coordinator 715-204-1180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: WI 10047-16) |
| Enumeration Date | 2017-11-17 |
| Last Update Date | 2017-11-17 |