Provider Demographics
NPI:1104928597
Name:RAU, BRIAN C (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:RAU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 ROYAL TROON CT
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4620
Mailing Address - Country:US
Mailing Address - Phone:414-803-7696
Mailing Address - Fax:
Practice Address - Street 1:411 E WISCONSIN AVE STE 525
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4462
Practice Address - Country:US
Practice Address - Phone:414-271-2058
Practice Address - Fax:414-271-9777
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice