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General NPI Number Information
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NPI Number | 1699837138
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Entity Type | Organization
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Legal Business Name | OAKPARK DENTAL - EAU CLAIRE
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4605 ROYAL DR
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City | EAU CLAIRE
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State | WI
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Zip | 54701-2928
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Country | US
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Telephone | 715-855-9220
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Fax | 715-855-9225
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Provider Business Mailing Address
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Address Line | 4605 ROYAL DR
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City | EAU CLAIRE
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State | WI
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Zip | 54701-2928
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Country | US
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Telephone | 715-855-9220
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Fax | 715-855-9225
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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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