Organization
DENTAL IMPLANT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENIE KUBLE (CONTACT OFFICER)
(920) 450-0157
Entity
Organization
Contact information
Practice address
1202 COUNTY ROAD PH, SUITE 300, ONALASKA, WI 54650-8439
(608) 783-7330
Mailing address
1202 COUNTY ROAD PH, SUITE 300, ONALASKA, WI 54650-8439
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
09/24/2010
Last updated
09/24/2010
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