Organization
MAPLE RIDGE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENIE KUBLE (CONTACT OFFICER)
(920) 450-0157
Entity
Organization
Contact information
Practice address
3110 CRAIG RD, EAU CLAIRE, WI 54701-6186
(715) 552-7227
Mailing address
3110 CRAIG RD, EAU CLAIRE, WI 54701-6186
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/02/2011
Last updated
06/26/2012
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