=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083928402
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA LIN IGOWSKY DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2010
-----------------------------------------------------
Last Update Date | 12/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1313 N TAYLOR DR
-----------------------------------------------------
City | SHEBOYGAN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53081-3041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-452-7336
-----------------------------------------------------
Fax | 920-453-9770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1313 N TAYLOR DR
-----------------------------------------------------
City | SHEBOYGAN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53081-3041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-452-7336
-----------------------------------------------------
Fax | 920-453-9770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 6559015
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------