Provider Demographics
NPI:1174644298
Name:NEEDHAM, TODD L (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:L
Last Name:NEEDHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 NORTHERN RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-8753
Mailing Address - Country:US
Mailing Address - Phone:920-731-3224
Mailing Address - Fax:920-731-2910
Practice Address - Street 1:2535 NORTHERN RD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-8753
Practice Address - Country:US
Practice Address - Phone:920-731-3224
Practice Address - Fax:920-731-2910
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1514G1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics