Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 5224 | WI |
NPI | 1093924326 |
---|---|
Provider Name | Ryan J Auth |
First Address | Appleton, WI 54914-3011 |
Second Address | Appleton, WI 54914-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |