Provider Demographics
NPI:1225195837
Name:RUBENZER, ANGELA M (DDS)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:RUBENZER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:VEIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:400 2ND ST S STE 250
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1599
Mailing Address - Country:US
Mailing Address - Phone:715-808-0460
Mailing Address - Fax:
Practice Address - Street 1:400 2ND ST S STE 250
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1599
Practice Address - Country:US
Practice Address - Phone:715-808-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12166122300000X
WI7171-151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist