Michael J.Revenig DDS, Glenn D. Wilson DDS, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MICHAEL J.REVENIG DDS, GLENN D. WILSON DDS, PLLC

Practice address

4601 Brainerd Rd
Chattanooga, TN 37411-3826

Phone

(423) 698-6005

Fax

(423) 698-6410

NPI assigned

Aug 6, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lisa U Revenig

Title

Owner's Wife

Phone

(423) 698-6005

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1375747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375747200000",
    "number": "1821420464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 BRAINERD RD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374113826",
            "telephone_number": "423-698-6005",
            "fax_number": "423-698-6410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 BRAINERD RD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374113826",
            "telephone_number": "423-698-6005",
            "fax_number": "423-698-6410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J.REVENIG DDS, GLENN D. WILSON DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-06",
        "last_updated": "2013-08-06",
        "status": "A",
        "authorized_official_last_name": "REVENIG",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "OWNER'S WIFE",
        "authorized_official_telephone_number": "423-698-6005"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hayden McCord Mezick, MD
• Nomathamsanqa Louise Mgutshini
• Michael D Vaughan DDS and Associates of Chattanooga PLLC
• Michael Duvall DDS PLLC
• Michael Geer PC
• Michael W Goodman MD PC
• Nancy G. Michaelis, M.D.
• David J Michaels, AGACNP-BC
• Ashlee N Micheff, RN
• Joan Stewart Mickles, NCC

• General Practice Dentistry in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.