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General NPI Number Information
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NPI Number | 1316152085
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Entity Type | Individual
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Provider Name | TODD WALTER RASCH D.D.S., M.S.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 06/08/2010
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Provider Practice Location Address
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Address Line | N35W23770 CAPITOL DR STE B
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City | PEWAUKEE
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State | WI
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Zip | 53072-2639
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Country | US
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Telephone | 262-956-6000
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Fax | 262-691-2572
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Provider Business Mailing Address
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Address Line | N35W23770 CAPITOL DR STE B
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City | PEWAUKEE
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State | WI
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Zip | 53072-2639
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Country | US
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Telephone | 262-956-6000
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Fax | 262-691-2572
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 6251-15
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License Number State | WI
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