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General NPI Number Information
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NPI Number | 1497266910
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Entity Type | Individual
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Provider Name | DONALD ERVIN LINNEMAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2017
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Last Update Date | 10/24/2017
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Provider Practice Location Address
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Address Line | CENTER 4820 N SHERMAN ROAD WINNEBAGO CORRECTION CENTER, DRUG ABUSE CORRECTIONAL
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City | WINNEBAGO
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State | WI
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Zip | 54985-0036
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Country | US
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Telephone | 920-236-2700
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Fax | 920-426-5601
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Provider Business Mailing Address
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Address Line | P.O. BOX 7925, 3099 E. WASHINGTON AVE WISCONSIN DEPT OF CORRECTIONS BUREAU OF HEALTH SERVICES
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City | MADISON
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State | WI
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Zip | 53707-7925
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Country | US
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Telephone | 608-240-5000
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Fax | 608-240-3311
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 5002018
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License Number State | WI
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