Provider Demographics
NPI:1740733138
Name:KUEBLER, RYAN PAUL (DMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:PAUL
Last Name:KUEBLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40W320 LA FOX RD.
Mailing Address - Street 2:SUITE D
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175
Mailing Address - Country:US
Mailing Address - Phone:630-388-9999
Mailing Address - Fax:
Practice Address - Street 1:40W320 LA FOX RD.
Practice Address - Street 2:SUITE D
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175
Practice Address - Country:US
Practice Address - Phone:630-388-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030717122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist