| NPI | 1386715662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENIE KUBLE Contact Officer 920-450-0157 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 4060) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2020-08-22 |