| NPI | 1992806269 |
|---|---|
| Former Legal Business Name | SOUTHERN WISCONSIN ORAL & MAXILLOFACIAL SURGERY S.C. |
| Entity Type | Organization |
| Authorized Contact | CRYSTAL M DIETER Manager 608-756-8744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 5E10250) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2012-06-11 |