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Mason P Wistenberg
Student in an Organized Health Care Education/Training Program in Green Bay, Wisconsin
NPI 1780278283

Mason P Wistenberg is a Student in an Organized Health Care Education/Training Program based in Green Bay, WI. Mason P Wistenberg practices in Green Bay, WI. The NPI Number for Mason P Wistenberg is 1780278283 and holds a License No. 1002699-15 (Wisconsin).

The current practice location address for Mason P Wistenberg is 3071 Voyager Dr Ste B, Green Bay, WI and can be reached out via phone at 920-465-9887.

Location: 3071 Voyager Dr Ste B, Green Bay, WI, 54301-2607
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1780278283
Provider Name
Mason P Wistenberg
Credential
Provider Entity Type
Individual
Gender
Male
Address
3071 Voyager Dr Ste B, Green Bay, WI, 54301-2607
Phone Number
920-465-9887
Fax Number
Provider Enumeration Date
02/24/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
3071 Voyager Dr Ste B
City
Green Bay
State
Wisconsin
Zip
54311-8352
Phone Number
920-465-9887
Fax Number
person
Provider Business Mailing Address Details
Address
3071 Voyager Dr Ste B
City
Green Bay
State
Wisconsin
Zip
54311-8352
Phone Number
920-465-9887
Fax Number
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
General Practice
Taxonomy
1223G0001X
License No.
()
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
1002699-15 (Wisconsin)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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