Organization
FALL CREEK FAMILY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENIE KUBLE (NPI AUTHORIZED OFFICIAL)
(920) 450-0157
Entity
Organization
Contact information
Practice address
122 S STATE ST, FALL CREEK, WI 54742-9701
(715) 877-2113
Mailing address
122 S STATE ST, FALL CREEK, WI 54742-9701
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
02/12/2024
Last updated
02/12/2024
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