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General NPI Number Information
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NPI Number | 1063634228
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Entity Type | Organization
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Legal Business Name | RENNER AND MARTIN DDS SC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1111 DELAFIELD ST. #319
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City | WAUKESHA
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State | WI
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Zip | 53188-3407
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Country | US
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Telephone | 262-549-3640
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Fax |
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Provider Business Mailing Address
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Address Line | 903 LYNNE COURT
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City | WAUKESHA
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State | WI
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Zip | 53186-3407
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Country | US
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Telephone | 262-547-8780
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM ROBERT RENNER
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Credential | DDS
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Telephone | 262-549-3640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5002149-015
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License Number State | WI
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