Southworth Dental

NPI #1699015974 in Wausau, Wisconsin

Provider Information

NPI Number: 1699015974
Entity Type: Organization
Organization Name: Southworth Dental
Primary Specialty: Dentist - General Practice
Enumeration Date: Feb 22, 2013
Last Updated: Feb 22, 2013

Practice Location

Address: 609 JACKSON ST
City: Wausau
State: Wisconsin
ZIP Code: 54403-5550
Phone: (715) 842-1935

Authorized Official

Name: GENIE KUBLE
Title: CONTACT OFFICER
Phone: (920) 450-0157

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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