Brueggeman, Lysette Lucille
Brueggeman, Lysette Lucille is an individual health care provider with primary practice located at 145 N 18Th Avenue , West Bend WI 53095. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Brueggeman, Lysette Lucille can be contacted via phone (262) 334-3084.Contact Information
Primary practice address
145 N 18Th Avenue
West Bend WI 53095
Phone: (262) 334-3084
Fax: (262) 334-3552
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 4368 | Wisconsin |
Profile Details
| NPI number | 1639234677 |
|---|---|
| LBN Legal business name | Brueggeman, Lysette Lucille |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 27th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639234677 | NPPES |
| Wisconsin | MEDICAID | 33713000 | |
| Wisconsin | Other | 650286 |
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