| NPI | 1982068508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER CHRISTOPHERSON Owner/Dentist 715-344-9684 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WI 6947-015) |
| Enumeration Date | 2016-04-09 |
| Last Update Date | 2016-04-09 |