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Organization
MICHAEL J.REVENIG DDS, GLENN D. WILSON DDS, PLLC
Active
Organization
MICHAEL J.REVENIG DDS, GLENN D. WILSON DDS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA U REVENIG (OWNER'S WIFE)
(423) 698-6005
Entity
Organization
Contact information
Practice address
4601 BRAINERD RD, CHATTANOOGA, TN 37411-3826
(423) 698-6005
(423) 698-6410
Mailing address
4601 BRAINERD RD, CHATTANOOGA, TN 37411-3826
(423) 698-6005
(423) 698-6410
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/06/2013
Last updated
08/06/2013
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