Individual
LYNN M BRENEMAN-WISONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
125 SCOTT ST, DAVENPORT, IA 52801-1130
(563) 336-3221
(563) 336-3229
Mailing address
500 W RIVER DR, DAVENPORT, IA 52801-1014
(563) 336-3000
(563) 336-3229
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
08399
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0080200
—
IA
01
—
08399
PRIVATE INSURANCES
IA
01
—
1875119
UNITED CONCORDIA
IA
01
—
22006
IA BLUE DENTAL
IA
05
—
9183715
—
IL
Enumeration date
12/12/2006
Last updated
04/29/2013
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