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General NPI Number Information
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NPI Number | 1609973668
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Entity Type | Individual
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Provider Name | WILLIAM ROBERT RENNER D. D. S.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1111 DELAFIELD ST STE 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 | 262-549-3511
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Provider Business Mailing Address
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Address Line | 903 LYNNE CT
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City | WAUKESHA
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State | WI
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Zip | 53186-6812
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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 |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 5002149-015
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License Number State | WI
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