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Organization

MICHAEL J.REVENIG DDS, GLENN D. WILSON DDS, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LISA U REVENIG (OWNER'S WIFE)
(423) 698-6005
Entity
Organization

Contact information

Practice address
4601 BRAINERD RD, CHATTANOOGA, TN 37411-3826
(423) 698-6005
(423) 698-6410
Mailing address
4601 BRAINERD RD, CHATTANOOGA, TN 37411-3826
(423) 698-6005
(423) 698-6410

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Enumeration date
08/06/2013
Last updated
08/06/2013
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