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General NPI Number Information
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NPI Number | 1154415263
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Entity Type | Individual
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Provider Name | TODD KEITH ENGEL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12660 W NORTH AVE BUILDING D
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City | BROOKFIELD
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State | WI
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Zip | 53005-4633
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Country | US
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Telephone | 262-432-1600
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Fax | 262-432-0227
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Provider Business Mailing Address
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Address Line | 12660 W NORTH AVE BUILDING D
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City | BROOKFIELD
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State | WI
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Zip | 53005-4633
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Country | US
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Telephone | 262-432-1600
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Fax | 262-432-0227
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 4765-015
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License Number State | WI
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