Dr Larry Lee Nillissen, DDS is a
Dentist based in Birnamwood, Wisconsin. Dr Larry Lee Nillissen is licensed to practice in Wisconsin (license number WI2723) and his current practice location is
409a Main St, Birnamwood, Wisconsin. He can be reached at his office (for appointments etc.) via phone at
(715) 449-3345.
NPI number for Dr Larry Lee Nillissen is 1518121284 and his current mailing address is Po Box 206, 409a Main St, Birnamwood, Wisconsin. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1518121284.
Healthcare Provider's Profile
| Full Name | Dr Larry Lee Nillissen |
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| Gender | Male |
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| Speciality | Dentist |
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| Location | 409a Main St, Birnamwood, Wisconsin |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1518121284
- Provider Enumeration Date: 07/11/2008
- Last Update Date: 07/11/2008
Medical Identifiers
Medical identifiers for Dr Larry Lee Nillissen such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1518121284 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 122300000X | Dentist | WI2723 (Wisconsin) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Larry Lee Nillissen is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Larry Lee Nillissen, DDS
Po Box 206, 409a Main St,
Birnamwood, WI 54414-0206
Ph: (715) 449-3345 | Dr Larry Lee Nillissen, DDS
409a Main St,
Birnamwood, WI 54414-0206
Ph: (715) 449-3345 |
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