=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932560604
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR PETER LOTOWSKI LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2016
-----------------------------------------------------
Last Update Date | 03/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1260 W MAIN ST # 1
-----------------------------------------------------
City | SUN PRAIRIE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53590-1930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-834-6321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1260 W MAIN ST # 1
-----------------------------------------------------
City | SUN PRAIRIE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53590-1930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-834-6321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | MR. PETER LOTOWSKI
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 608-834-6321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------