Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 3975 | WI |
NPI | 1033108287 |
---|---|
Provider Name | Dr. Timothy Francis Flood |
First Address | Onalaska, WI 54650-8656 |
Second Address | Onalaska, WI 54650-8656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 08/07/2007 |