Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 1001213 | WI |
NPI | 1164492377 |
---|---|
Provider Name | Dr. Edward Thomas Breecher |
First Address | Franklin, WI 53132-8045 |
Second Address | Franklin, WI 53132-8045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 21/09/2020 |