Individual
LYSETTE LUCILLE BRUEGGEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
145 N 18TH AVENUE, WEST BEND, WI 53095
(262) 334-3084
(262) 334-3552
Mailing address
145 N 18TH AVENUE, WEST BEND, WI 53095
(262) 334-3084
(262) 334-3552
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4368
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33713000
—
WI
01
—
650286
UNITED CONCORDIA
—
Enumeration date
12/27/2006
Last updated
07/08/2007
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