| NPI | 1992217053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA KIECKER Owner 608-241-1579 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: WI 6337) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental (Licence: WI 50015111) |
| 261QD0000X Clinic/Center Dental | |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2023-07-12 |