Anderson, Theodore Michael

Anderson, Theodore Michael is an individual health care provider with primary practice located at 3637 Wilgus Avenue , Sheboygan WI 53081. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Anderson, Theodore Michael can be contacted via phone (920) 458-8213.

Contact Information

Primary practice address
3637 Wilgus Avenue Sheboygan WI 53081
Phone: (920) 458-8213
Fax: (920) 459-9797
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 4516015 Wisconsin

Profile Details

NPI number 1134178163
LBN Legal business name Anderson, Theodore Michael
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 8th, 2006
Last updated Jan 6th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134178163 NPPES
Wisconsin MEDICAID 33741300

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