| Southworth Dental | |
|
609 Jackson St Wausau WI 54403-5550 | |
| (715) 842-1935 | |
| Not Available |
| Full Name | Southworth Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 609 Jackson St, Wausau, Wisconsin |
| Authorized Official Name and Position | Genie Kuble (CONTACT OFFICER) |
| Authorized Official Contact | 9204500157 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southworth Dental 609 Jackson St Wausau WI 54403-5550 Ph: () - | Southworth Dental 609 Jackson St Wausau WI 54403-5550 Ph: (715) 842-1935 |
| NPI Number | 1699015974 |
|---|---|
| Provider Enumeration Date | 02/22/2013 |
| Last Update Date | 02/22/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699015974 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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