Healthcare Provider Details

I. General information

NPI: 1518976356
Provider Name (Legal Business Name): DENTISTRY BY DESIGN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E BELL ST
NEENAH WI
54956-4993
US

IV. Provider business mailing address

1424 SEYMOUR CT
NEENAH WI
54956-4975
US

V. Phone/Fax

Practice location:
  • Phone: 920-725-8505
  • Fax: 920-725-8569
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5271
License Number StateWI

VIII. Authorized Official

Name: DR. TIMOTHY STEPHAN TWEEDY
Title or Position: PARTNER/DENTIST
Credential: D.D.S.
Phone: 920-725-8505