Provider Demographics
NPI:1902286347
Name:KUEBLER, JOLYNN
Entity Type:Individual
Prefix:
First Name:JOLYNN
Middle Name:
Last Name:KUEBLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 POTTAWATOMIE TRL
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-8336
Mailing Address - Country:US
Mailing Address - Phone:920-915-2141
Mailing Address - Fax:
Practice Address - Street 1:1147 BUTTERFIELD RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-8807
Practice Address - Country:US
Practice Address - Phone:630-621-9657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39-12090881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice