| NPI | 1053440842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENIE KUBLE Contact Officer 920-450-0157 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2020-08-22 |