Provider Demographics
NPI:1033349956
Name:NEUBURG, KRISTINE KIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:KIM
Last Name:NEUBURG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 SOUTH MAIN ST.
Mailing Address - Street 2:THE GENTLE DENTAL EMPORIUM, LLC
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095
Mailing Address - Country:US
Mailing Address - Phone:262-338-8704
Mailing Address - Fax:262-338-9140
Practice Address - Street 1:533 SOUTH MAIN ST.
Practice Address - Street 2:THE GENTLE DENTAL EMPORIUM LLC
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095
Practice Address - Country:US
Practice Address - Phone:262-338-8704
Practice Address - Fax:262-338-9140
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI5624122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist