Healthcare Provider Details

I. General information

NPI: 1053440842
Provider Name (Legal Business Name): OAKPARK DENTAL - PLATTEVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 N WATER ST
PLATTEVILLE WI
53818-1450
US

IV. Provider business mailing address

1250 N WATER ST
PLATTEVILLE WI
53818-1450
US

V. Phone/Fax

Practice location:
  • Phone: 608-348-9591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: GENIE KUBLE
Title or Position: CONTACT OFFICER
Credential:
Phone: 920-450-0157