Healthcare Provider Details

I. General information

NPI: 1639325756
Provider Name (Legal Business Name): BRIAN J. SERRES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 LAKELAND DRIVE
CHIPPEWA FALLS WI
54729-1687
US

IV. Provider business mailing address

1000 N OAK AVENUE
MARSHFIELD WI
54449-5703
US

V. Phone/Fax

Practice location:
  • Phone: 715-738-2000
  • Fax:
Mailing address:
  • Phone: 715-387-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6227-15
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6227
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: