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General NPI Number Information
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NPI Number | 1467528760
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Entity Type | Organization
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Legal Business Name | PARK PLACE DENTAL CARE
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1551 PARK PL SUITE 300
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City | GREEN BAY
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State | WI
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Zip | 54304-1982
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Country | US
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Telephone | 920-497-8500
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Fax | 920-497-3213
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Provider Business Mailing Address
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Address Line | 1551 PARK PL SUITE 300
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City | GREEN BAY
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State | WI
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Zip | 54304-1982
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Country | US
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Telephone | 920-497-8500
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Fax | 920-497-3213
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Authorized Official
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Title or Position | CONTACT OFFICER
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Name | GENIE KUBLE
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Credential |
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Telephone | 920-450-0157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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