Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 6141-016 | WI |
NPI | 1043486228 |
---|---|
Provider Name | Mr. Franklin Fredrick Wileman |
First Address | Custer, WI 54423-9427 |
Second Address | Custer, WI 54423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2008 |
Last Update Date | 07/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33806300 | (05) | WI |