Organization
TWIN PORTS DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENIE KUBLE (CONTACT OFFICER)
(920) 450-0157
Entity
Organization
Contact information
Practice address
1507 TOWER AVE, ROOM 427, SUPERIOR, WI 54880-2532
(715) 394-5792
Mailing address
1507 TOWER AVE, ROOM 427, SUPERIOR, WI 54880-2532
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/22/2010
Last updated
07/22/2010
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