Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 0004656-015 | WI |
NPI | 1013931823 |
---|---|
Provider Name | Dr. William Arthur Brennan |
First Address | Appleton, WI 54913-7502 |
Second Address | Green Bay, WI 54301-5115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33725800 | (05) | WI |