Organization
SOUTHWORTH DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENIE KUBLE (CONTACT OFFICER)
(920) 450-0157
Entity
Organization
Contact information
Practice address
609 JACKSON ST, WAUSAU, WI 54403-5550
(715) 842-1935
Mailing address
609 JACKSON ST, WAUSAU, WI 54403-5550
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
02/22/2013
Last updated
02/22/2013
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