Provider Demographics
NPI:1275536161
Name:TWOHIG, WILLIAM J (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:TWOHIG
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:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:WEYAUWEGA
Mailing Address - State:WI
Mailing Address - Zip Code:54983-0579
Mailing Address - Country:US
Mailing Address - Phone:920-867-3101
Mailing Address - Fax:920-867-3108
Practice Address - Street 1:417 E ANN ST
Practice Address - Street 2:
Practice Address - City:WEYAUWEGA
Practice Address - State:WI
Practice Address - Zip Code:54983-8532
Practice Address - Country:US
Practice Address - Phone:920-867-3101
Practice Address - Fax:920-867-3108
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50016301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33562400Medicaid
WI898039OtherUNITED CONCORDIA PROVIDER