Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | IL | |
N | 1223P0700X | Prosthodontist | IL | |
N | 1223P0700X | Prosthodontist | 5000-942-015 | WI |
NPI | 1265451744 |
---|---|
Provider Name | Dr. George Eugene Rooney JR. |
First Address | Brookfield, WI 53045-4922 |
Second Address | Wauwatosa, WI 53222-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33414800 | (05) | WI |