Organization
GENEVA FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENIE KUBLE (CONTACT OFFICER)
(920) 450-0157
Entity
Organization
Contact information
Practice address
851 PARK DR, SUITE 101, LAKE GENEVA, WI 53147-4586
(262) 248-4991
(262) 248-0397
Mailing address
851 PARK DR, SUITE 101, LAKE GENEVA, WI 53147-4586
(262) 248-4991
(262) 248-0397
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4060
WI
Other
Enumeration date
11/20/2006
Last updated
08/22/2020
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