# MICHAEL J.REVENIG DDS, GLENN D. WILSON DDS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821420464
- **Authorized official:** LISA U REVENIG (OWNER'S WIFE)
- **Authorized official phone:** (423) 698-6005

## Contact information

- **Practice address:** 4601 BRAINERD RD, CHATTANOOGA, TN 37411-3826
- **Practice address phone:** (423) 698-6005
- **Practice address fax:** (423) 698-6410
- **Mailing address:** 4601 BRAINERD RD, CHATTANOOGA, TN 37411-3826
- **Mailing address phone:** (423) 698-6005
- **Mailing address fax:** (423) 698-6410

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/06/2013
- **Last updated:** 08/06/2013