Provider Demographics
NPI:1437239209
Name:POMERENING, BRUCE LEE (DDS)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:LEE
Last Name:POMERENING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SOUTH BEAUMONT RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821
Mailing Address - Country:US
Mailing Address - Phone:608-326-2332
Mailing Address - Fax:
Practice Address - Street 1:109 SOUTH BEAUMONT RD
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821
Practice Address - Country:US
Practice Address - Phone:608-326-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI53134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist