Provider Demographics
NPI:1447358296
Name:MOMSEN, LYNN MARIE BIELMEIER (DDS)
Entity type:Individual
Prefix:DR
First Name:LYNN MARIE
Middle Name:BIELMEIER
Last Name:MOMSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 199
Mailing Address - Street 2:
Mailing Address - City:WILD ROSE
Mailing Address - State:WI
Mailing Address - Zip Code:54984-0199
Mailing Address - Country:US
Mailing Address - Phone:920-622-3118
Mailing Address - Fax:920-622-3138
Practice Address - Street 1:474 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:WILD ROSE
Practice Address - State:WI
Practice Address - Zip Code:54984
Practice Address - Country:US
Practice Address - Phone:920-622-3118
Practice Address - Fax:920-622-3138
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48430751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice