Individual
DR. JACK L BRICKNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5553 WATERFORD LN, APPLETON, WI 54913-8468
(920) 739-7165
Mailing address
4540 ALGONQUIN TRL, GREEN BAY, WI 54313-9527
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5001371G
WI
Other
Enumeration date
01/09/2007
Last updated
01/15/2009
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