Organization
FONTANA FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENIE KUBEL (CONTACT OFFICER)
(920) 450-0157
Entity
Organization
Contact information
Practice address
450 MILL ST STE 101, FONTANA, WI 53125-1242
(262) 275-8080
(262) 275-5890
Mailing address
450 MILL ST STE 101, FONTANA, WI 53125-1242
(262) 275-8080
(262) 275-5890
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/14/2006
Last updated
08/22/2020
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