Individual
DR. BRYAN L. WIERWILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5601 ODANA RD, MADISON, WI 53719-1207
(608) 274-9077
(608) 274-9103
Mailing address
5601 ODANA RD, MADISON, WI 53719-1207
(608) 274-9077
(608) 274-9103
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
502001G
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
391362618
TAX ID
WI
Enumeration date
12/06/2006
Last updated
05/18/2010
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