Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 3167 015 | WI |
NPI | 1003942509 |
---|---|
Provider Name | Susan Elizabeth Freundl |
First Address | Wauwatosa, WI 53226 |
Second Address | Milwaukee, WI 56204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |