Individual
GLENN JOHN WISNIESKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
409 ROOSEVELT RD, WALKERTON, IN 46574
(574) 586-3242
(574) 686-3242
Mailing address
409 ROOSEVELT RD, WALKERTON, IN 46574
(574) 586-3242
(574) 686-3242
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12007003A
IN
Other
Enumeration date
03/20/2007
Last updated
07/08/2007
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