Organization
RENNER AND MARTIN DDS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM ROBERT RENNER DDS (OWNER)
(262) 549-3640
Entity
Organization
Contact information
Practice address
1111 DELAFIELD ST. #319, WAUKESHA, WI 53188-3407
(262) 549-3640
Mailing address
903 LYNNE COURT, WAUKESHA, WI 53186-3407
(262) 547-8780
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5002149-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33399400
BADGERCARE
WI
Enumeration date
05/03/2007
Last updated
08/22/2020
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