Healthcare Provider Details

I. General information

NPI: 1639004237
Provider Name (Legal Business Name): GLENN WOLFGANG HAIDINGER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SHERRY AVE
PARK FALLS WI
54552-1468
US

IV. Provider business mailing address

314 6TH AVE S
PARK FALLS WI
54552-1022
US

V. Phone/Fax

Practice location:
  • Phone: 715-762-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6002219
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: