1376103572 NPI number — WILLIAM J TWOHIG DDS LLC

Table of content: (NPI 1376103572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376103572 NPI number — WILLIAM J TWOHIG DDS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM J TWOHIG DDS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DR. WILLIAM J. TWOHIG DDS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376103572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 579
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEYAUWEGA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54983-0579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-867-3101
Provider Business Mailing Address Fax Number:
920-867-3101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
417 E ANN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEYAUWEGA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54983-8532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-867-3101
Provider Business Practice Location Address Fax Number:
920-867-3108
Provider Enumeration Date:
06/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
TWOHIG
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
920-867-3101

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com