Provider Demographics
NPI:1891575882
Name:CUBA CITY FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:CUBA CITY FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-744-2111
Mailing Address - Street 1:206 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:CUBA CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53807-1147
Mailing Address - Country:US
Mailing Address - Phone:608-744-2111
Mailing Address - Fax:608-744-2112
Practice Address - Street 1:206 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:CUBA CITY
Practice Address - State:WI
Practice Address - Zip Code:53807-1147
Practice Address - Country:US
Practice Address - Phone:608-744-2111
Practice Address - Fax:608-744-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental