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General NPI Number Information
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NPI Number | 1831562156
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Entity Type | Organization
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Legal Business Name | NORTHPARK DENTAL LLC
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Dates
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Enumeration Date | 11/09/2015
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 235 W PRAIRIE VIEW RD STE 1
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-3639
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Country | US
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Telephone | 715-720-9125
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Fax |
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Provider Business Mailing Address
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Address Line | 235 W PRAIRIE VIEW RD STE 1
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-3639
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Country | US
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Telephone |
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Fax |
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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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