Maxwell Reisner, DDS
Individual provider Active NPI General Practice Dentistry · Chetek, WI
NPI 1700527488 · NPPES record last updated Jun 20, 2022
Key facts
- NPI
- 1700527488
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 6000027-15 (WI)
- Practice address
- 912 24 1/2 St
Chetek, WI 54728-7925 - Phone
- (715) 859-2202
- NPI assigned
- Apr 5, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6000027-15 | WI | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6000027-15 | WI | Yes |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
912 24 1/2 St
Chetek, WI 54728-7925
Mailing address
912 24 1/2 St
Chetek, WI 54728-7925
Other practice location 1
1801 W Wisconsin Ave
Milwaukee, WI 53233-2186
Phone (715) 642-0274
Other providers in Chetek, WI
- Jeffrey M Marquardt
- Charles Mikow
- Diana Odagard
- Outback Chiropractic LLC
- Pharmacare LTD
- Deanne Ruppel
- Sather Family Dental, LLC
- Nik Edward Sather
- Sharon Ann Schumacher
- Trevor Secraw
All providers in Chetek, WI · General Practice Dentistry in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.