Provider Demographics
NPI:1063634228
Name:RENNER AND MARTIN DDS SC
Entity Type:Organization
Organization Name:RENNER AND MARTIN DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:RENNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-549-3640
Mailing Address - Street 1:903 LYNNE COURT
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-3407
Mailing Address - Country:US
Mailing Address - Phone:262-547-8780
Mailing Address - Fax:
Practice Address - Street 1:1111 DELAFIELD ST. #319
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3407
Practice Address - Country:US
Practice Address - Phone:262-549-3640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5002149-015261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33399400OtherBADGERCARE