Individual
AUSTIN REID IMERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
880 14TH ST, BARABOO, WI 53913-1540
(608) 356-6611
Mailing address
434 SIDNEY ST, MADISON, WI 53703-1724
(641) 757-1099
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1001360 - 15
WI
Other
Enumeration date
06/23/2016
Last updated
06/23/2016
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