Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 4765-015 | WI |
NPI | 1154415263 |
---|---|
Provider Name | Dr. Todd Keith Engel |
First Address | Brookfield, WI 53005-4633 |
Second Address | Brookfield, WI 53005-4633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |