| NPI | 1972697563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JOHN KOSOVEC President 608-241-1579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5001511) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-08-22 |